Anne Harrison

Aging of the Somatosensory System: A Translational Perspective

Balance in the elderly population is a major concern given the often catastrophic and disabling consequences of fall-related injuries. Structural and functional declines of the somatosensory system occur with aging and potentially contribute to postural instability in older adults. The objectives of this article are: (1) to discuss the evidence regarding age-related anatomical and physiological changes that occur in the peripheral proprioceptive and cutaneous systems, (2) to relate the basic science research to the current evidence regarding clinical changes associated with normal aging, and (3) to review the evidence regarding age-related proprioceptive and cutaneous clinical changes and relate it to research examining balance performance in older adults. The article is organized by an examination of the receptors responsible for activating afferent pathways (muscle spindle, golgi tendon organ, and articular and cutaneous receptors) and the corresponding sensory afferent fibers and neurons. It integrates basic science laboratory findings with clinical evidence suggesting that advanced aging results in a decline in cutaneous sensation and proprioception. The potential relationship between postural instability and sensory impairments in older adults also is discussed. Current laboratory and clinical evidence suggests that aging results in: (1) diverse and nonuniform declines in the morphology and physiological function of the various sensory structures examined, (2) preferential loss of distal large myelinated sensory fibers and receptors, and (3) impaired distal lower-extremity proprioception, vibration and discriminative touch, and balance. These findings provide foundational knowledge that emphasizes the importance of using reliable and valid sensory testing protocols for older adults and the need for further research that clarifies the relationship between sensory impairment and balance.

Living with traumatic brain injury in a rural setting: supports and barriers across the continuum of care

Abstract Purpose: Traumatic brain injury (TBI) is prevalent in Kentucky and comes with a high cost in care and quality of life for individuals and caregivers affected. Many people living with the condition of TBI have unmet needs. Research among people living with TBI in rural areas is limited. The purposes of this study were to (1) increase understanding of the lived experience of people with TBI and caregivers in rural regions of Kentucky across the continuum of their care and (2) provide their perspectives on barriers and facilitators of optimal function and well-being. Methods: A qualitative descriptive interview study was conducted by a multidisciplinary team. Content analysis was completed with data-derived coding and iterative modifications to analysis, coalescing codes into categories and themes. Results: Thirteen people with TBI and six caregivers participated in the interview. Categories that emerged in analysis included the experiences under each locus of care; themes included relationships, functional competence, and participation in meaningful activity. Conclusion: Relationships represented both barriers and facilitators of well-being. Major unmet needs persisted in terms of medical problems, support for caregivers, community linkages, and participation in meaningful activities. Recommendations are made regarding avenues for addressing unmet needs. Implications for Rehabilitation People with TBI are living with chronic conditions and may need intensive rehabilitation after the injury and intermittent rehabilitation throughout life to develop and maintain functional competence. Rehabilitation providers need to understand the unique aspects of the rural home environment to which a patient will be discharged (e.g., mountainous terrain, lack of transportation, dimensions of home) and communicate with rural providers directly. Rehabilitation providers need additional focus on improving patient’s and caregiver’s abilities to advocate for themselves. Patients with TBI should be referred to vocational rehabilitation as soon as possible to make the transition to meaningful activity at home more of a possibility.

Becoming Occupation-Based: A Case Study

ABSTRACT This descriptive case study illustrates the experiences of a 55-year-old male with a chronic disability resulting from a stroke, living in the community and a clinicians trial using occupation-based interventions predominately in a rehabilitation setting. The participant engaged in occupation-based interventions three times a week for 5 weeks guided by the Canadian Occupational Performance Measure (COPM). Data were collected through semi-structured interviews during the intervention sessions and journal entries made by the therapist. Results suggested occupation-based interventions facilitated a transformation for both the client and the therapist by enhancing the participants occupational performance and the ability to resume previous roles. The therapists belief in the power and value of occupation-based practice was reinforced and validated, particularly in the rehabilitation of an individual with chronic stroke.

Interprofessional Qualitative Research Teams: The Experience of Stroke for Rural Individuals

This case study describes our experiences and perceptions of completing a qualitative study with a seven-person interprofessional team. We describe and highlight issues using examples from our work examining the experiences of individuals with stroke and caregivers living in rural Appalachian Kentucky. Components of the “method” in action that we address include team formation and leadership, regular team meetings and discussions, developing an interview guide, recruitment, conducting interviews, managing the data, dividing the labor and responsibilities, analyzing, and disseminating the findings as a team. We share practical lessons learned, including benefits, limitations, and strategies.

Occupational Therapists’ Perceptions of Environmental Influences on Practice at an Inpatient Stroke Rehabilitation Program: A Pilot Study

ABSTRACT Aims: To better understand occupational therapists’ clinical decision making processes as they selected which rehabilitation environment to work in, and how the therapists perceived the environment impacted their choice of intervention. Methods: Focus group and individual interviews were conducted following observation of three occupational therapists providing interventions for 16 months with 12 clients following a stroke at an inpatient rehabilitation hospital stroke unit. Therapists could chose from three different environments for interventions: a therapy gym, homelike space, or a combination space. Results: Three themes emerged that revealed therapists’ habits influenced their clinical reasoning; the environment influenced therapists’ intervention choices; and therapists felt safer treating in the gym environment. Conclusion: The environment influenced the therapists’ intervention choices as well as their clinical reasoning. Rehabilitation services on an inpatient stroke program may be improved if therapists increase their awareness of the influence of the environment on interventions.

Book Reviews : Rein Tideiksaar. Falls in Older Persons: Prevention and Management. Balti more: Health Professions Press, 1998. Paperback,

Despite these shortcomings, my evaluation of this volume is quite positive and I believe that gerontologists working in different domains can benefit a great deal from reading this book. I also realize that in edited volumes, desirable depth may be sacrificed to document the breadth of a particular topic. In light of these remarks, I find the efforts of the editors quite laudable and I hope that they may consider a follow-up volume that addresses more applied issues of everyday competence.