Birgitta Bernspång

Differences between persons with right or left cerebral vascular accident on the assessment of motor and process skills

OBJECTIVE Persons with right and left cerebral vascular accident (RCVA and LCVA) differ in terms of discrete impairments, but there is limited information with regard to how such impairments translate into differences in disability. The following hypotheses were tested: (1) persons with stroke have lower instrumental or domestic activities of daily living (IADL) ability than do matched nondisabled controls, (2) persons with RCVA do not differ from persons with LCVA in IADL ability, and (3) persons with RCVA and LCVA differ in specific motor and process skills that affect IADL performance. DESIGN Descriptive comparison. SETTING Subjects were tested in settings where rehabilitation services were received (home or clinic). SUBJECTS 71 persons with RCVA, 76 persons with LCVA, and 83 community-living nondisabled individuals drawn from the Assessment of Motor and Process Skills (AMPS) database, matched for age, gender, and number of tasks performed. MAIN OUTCOME MEASURE AMPS, designed to measure type and severity of impairments manifested in the context of IADL performance. The AMPS was administered to all subjects in accordance with standardized testing procedures. RESULTS The two stroke groups did not differ significantly in IADL ability, but both stroke groups had significantly lower IADL performance than did the nondisabled subjects. On the AMPS motor scale, persons with RCVA demonstrated greater impairment in pacing, transporting, and coordinating two body parts. Persons with LCVA demonstrated greater impairments in calibrating movements. No differences were found between the two groups in AMPS process skills. CONCLUSIONS Persons with RCVA and LCVA have hemisphere-specific differences in motor impairments, but do not differ significantly in IADL ability.

Motor and perceptual impairments in acute stroke patients: effects on self-care ability.

The relative importance of motor, perceptual, and some cognitive functions for self-care ability was analyzed in a representative sample of 109 subjects within 2 weeks of acute stroke. Forty-nine patients (45%) were dependent or partly dependent in self-care. Profound motor dysfunction was present in 39%, low-order perceptual deficits in 10%, high-order perceptual deficits in 60%, and disorientation in time and space in 13% of the patients. There was a significant covariation between motor function and self-care ability and between low-order perception and orientation function. Low-order and high-order perception covaried only weakly. Discriminant analyses showed that the actual level of self-care proficiency could be correctly predicted in 70% of the cases by the 4 indexes of motor function, low-order perception, high-order perception, and orientation. The dominating predictor was motor function, and the next highest was high-order perception. When a program for early training is designed with the aim to alleviate long-term self-care disability after stroke, correct assessment of motor and perceptual functions in the individual stroke patient is essential.

Development of the Assessment of Awareness of Disability

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

Cross-Cultural Assessment of Functional Ability

Culture and environment are known to influence performance of activities of daily living. Few functional assessments currently used in rehabilitation address the issue of cultural validity or relevance of the tasks that are used for assessment purposes. The Assessment of Motor and Process Skills (AMPS) addresses this problem by allowing the client to chose assessment tasks that are more relevant in their daily lives. We investigated the cross-cultural validity of the AMPS by contrasting test performance in subjects from two countries: the United States and Sweden. Data on 589 North American and Swedish subjects were submitted to Rasch analysis, and the results supported the validity of the AMPS in each country. Of the 35 AMPS items, only one item, Endures, differed significantly between the two samples. Overall item stability across samples indicated that the results obtained in both countries could be compared in a valid and meaningful way.

Predicting return to work after brain injury using occupational therapy assessments

Purpose: The aim of this study was to evaluate the value of occupational therapy assessments used in an outreach rehabilitation programme to predict return to work after brain injury. The assessments represent the ICIDH-2 levels of body function and activity. Method: Fifty-six persons in a late phase after brain injury who had been admitted to the rehabilitation programme during 2 years were followed up according to work status. The follow up was made at a minimum of 2 years after injury. Demographic data and scores from the occupational therapy assessments were compared for the two groups who were back to work or studies (BTW) and not back to work or studies (NBTW). Results: Assessments of memory, visual perception and apraxia separated between the two groups BTW and NBTW. Logistic regression showed that memory score in combination with data on PADL made up the best predictive model. In a subgroup with 21 persons where data on IADL were added to memory and PADL the predictive value was even stronger. Conclusions: In this study we found that occupational therapy assessments were valuable in predicting failure to return to work or studies after brain injury.

Participation in everyday occupations in a late phase of recovery after brain injury

The aim of this study was to describe to what extent individuals of working age, in a late phase after an acquired brain injury, participate in everyday occupations related to home maintenance, work, and leisure. The aim was also to evaluate if participation in different occupations influences their life satisfaction. A sample of 157 people consecutively admitted to a rehabilitation clinic between June 1995 and December 2000 answered a mailed questionnaire. The subjects who were of working age had had a brain injury on average 6 years before this study. The perceived participation was reported using the Reintegration to Normal Living Index (RNL) and life satisfaction according to an expanded version of the LiSat 11. This study showed that in this late phase of recovery after brain injury the subjects still experienced many restrictions in participation in everyday occupations. The area with the lowest reported participation was work activity while most comfort with the situation was reported for self-care. The RNL subscales showed a significant connection with satisfaction with life as a whole. Furthermore an interaction was found between the two subscales “Daily living” and “Perception of self”. This study showed restrictions in participation in the community even several years after brain injury, which underlines the need for rehabilitation services long after injury.

Occupational Engagement and Life Satisfaction in the Oldest-Old: The Umeå 85+ Study:

This study was designed to evaluate whether the level of occupational engagement is related to life satisfaction among the oldest-old. The study was performed as part of a cross-sectional study of individuals 85 years and older in northern Sweden. The results revealed significant correlations between life satisfaction and engagement in both leisure and activities of daily living, and the effect sizes were interpreted as medium. This study adds some support to earlier findings that a higher level of task performance is related to a higher level of life satisfaction. The results also give some clinical evidence to support a client-centered approach that includes consideration of leisure tasks a person is motivated to perform.

Life satisfaction related to work re-entry after brain injury: a longitudinal study.

Purpose: The aim of this study was to assess the subjective life satisfaction after brain injury and its relation to work re-entry. Method: The research design was a longitudinal study. Thirty-six individuals answered a questionnaire at 3 and 6 years after admittance to a rehabilitation programme. The questionnaire addressed work status, job satisfaction, subjective symptoms of illness and life satisfaction. Results: The reported life satisfaction both for life as a whole and for different domains of life was low. No significant difference between follow-ups was found for satisfaction with life as a whole. For the domain IADL activities, the subjects reported a statistically significant lower satisfaction at the second follow-up than at the first. No correlation between work status and subjective satisfaction with life as a whole was found in this population. At the second follow-up, significantly more people were satisfied with IADL in the group that had returned to work. Conclusions: The results from this study indicate that brain injury has a lasting effect on a person’s life also many years after onset. The decreasing satisfaction with the ability to perform IADL-activities in a long-term perspective should give implications for clinical practice. More research in this area is needed.

Focus on Leisure Repertoire in the Oldest Old: The Umeå 85+ Study

This study elucidates the oldest olds’ leisure repertoire and how this repertoire varies due to gender, where they live, and cognitive status. A validated 20-item leisure interest checklist with four subscales was used to measure leisure participation and investigate the leisure repertoire among participants. The oldest old were most likely to be interested in, perform, be motivated for, and perceive well-being from social activities, cultural activities, and TV/video/movies. The respondents were least likely to be interested in, perform, be motivated for, and perceive well-being from equipment sports and ball games. Some gender, geographic differences, and differences in cognitive status were found. The oldest old were more likely to endorse the same activities across all subscales of the checklist, but the linear magnitude varied across sub-scales. The relationships between performance and the other subscales suggested that a sense of engagement or participation is related to actual performance.

Client-Centred Occupational Therapy for Persons with Mental Retardation: Implementation of an Intervention Programme in Activities of Daily Living Tasks

The aim of this study was to implement a single-case design to evaluate the outcomes of a specified occupational therapy intervention programme. The intervention programme was based on a client-centred top-down approach and followed the Occupational Therapy Intervention Process Model. The interventions included both restorative and adaptive strategies to improve performance of the activities of daily living (ADL) tasks the participants defined as relevant and meaningful. Three women with moderate mental retardation living alone in apartments with support from professionals were included in the study. The Assessment of Motor and Process Skills was used to evaluate for changes in ADL motor and ADL process ability. The Assessment of Awareness of Disability was used to evaluate changes in the clients awareness of disability. The results showed improvements for all participants but patterns of changes were different between the participants and the outcome variables. ADL process ability was the only outcome variable that improved in all participants. The results are discussed in relation to the design used for evaluating intervention efficacy. Future improvements in the process of evaluating occupational therapy interventions are suggested.