Carolyn Baum

Screening Patients with Stroke for Rehabilitation Needs: Validation of the Post-Stroke Rehabilitation Guidelines

Background. The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. Methods. Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient’s chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. Results. Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). Conclusion. Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.

Evidence-Based Occupational Therapy:

“Is evidence-based health care just a passing fad, promoted by managers and purchasers enjoying their influence over clinical practice, but doomed to fail as a far too cumbersome method for dealing with the complexity and imprecision of real-life clinical decisions? ”

The contribution of occupation to function in persons with Alzheimer's disease

Abstract Occupation is known to play an important role in the maintenance of health. No study has explicitly explored the role that occupation (defined as continued engagement in instrumental, leisure, and social activities) plays in the maintenance of self care skills and management of disturbing behaviors in individuals with dementia of the Alzheimers type (DAT), nor has the relationship of memory, executive skills, and occupation been studied in this population. Seventy two couples, one spouse with DAT, were studied to explore these relationships and the role that occupation plays in their function. Individuals who remained active in occupation demonstrated fewer disturbing behaviors, required less help with basic self care, and their carers’ experienced less stress. Theoretical implications of findings are discussed.

Effect of Upper Extremity Nerve Damage on Activity Participation, Pain, Depression, and Quality of Life

PURPOSE To explore the relationship between upper extremity nerve damage and activity participation, pain, depression, and perceived quality of life. METHODS A total of 49 patients with upper extremity nerve damage completed standardized measures of activity participation, pain, depression, and quality of life. We analyzed scores for all subjects and for 2 diagnostic groups: patients with compressive neuropathy and patients with nerve injury (laceration, tumor, and brachial plexus injury), and explored predictors of overall quality of life. RESULTS Participants had given up 21% of their previous daily activities; greater activity loss was reported in patients with nerve injury. Pain was moderate and 39% had signs of clinical depression. Physical and psychological quality of life ratings were below the norms. Activity loss was strongly associated with higher levels of depression and lower physical and psychological quality of life. Higher depression scores correlated strongly with lower overall quality of life. Greater pain correlated moderately with higher depression scores and weakly with quality of life; no statistical relationship was found between pain and physical quality of life. Activity participation and depression predicted 61% of the variance in overall quality of life in patients with nerve damage. CONCLUSIONS The results of this study suggest that hand surgeons and therapists caring for patients with nerve compression and nerve injury should discuss strategies to improve activity participation, and decrease pain and depression, to improve overall effect on quality of life throughout the recovery process. Depression screening and referral when indicated should be included in the overall treatment plan for patients with upper extremity nerve damage. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.

Theoretical Foundations for the Measurement of Environmental Factors and Their Impact on Participation Among People With Disabilities

The ascendance of the World Health Organizations International Classification of Functioning, Disability and Heath (ICF) as the global standard for describing and characterizing aspects of disability has refocused attention on the role that environmental factors (EFs) have on the health and participation of people with disabilities, both as individuals and as a group. There has been a rise in the development of instruments designed to measure EFs alone and in relation to participation. Some instrument developers have used the ICF as a theoretical base for instrument development and to substantiate content validity claims. We contend that this is a misapplication of the ICF. There is a need to step back and reexamine the role that environmental theories can play in developing a conceptually driven approach to measuring the interaction between EFs and participation. For this review, we draw on the fields of social, community, and developmental psychology; disability studies; gerontology; public health; and rehabilitation. We discuss different approaches to the measurement of EFs. We suggest that given the complex nature of EFs and their influence on participation, there is a need for a fresh approach to EF measurement. The thoughtful application of theories and the use of advanced psychometric, measurement, and e-technologies and data visualization methods may enable researchers and clinicians to better quantify, document, and communicate the dynamic interrelationship between EFs and participation and health outcomes for people with disabilities at the individual, group, and population levels.

A Quantitative Analysis of Apraxia in Senile Dementia of the Alzheimer Type: Stage-Related Differences in Prevalence and Type

Apraxia is clinically separable from other cognitive dysfunctions and has the potential to interfere with motor performance in everyday living. To determine its prevalence and severity at each stage o

Measuring treatment fidelity in a rehabilitation intervention study.

ABSTRACTAttaining and demonstrating treatment fidelity is critical in the development and testing of evidence-based interventions. Treatment fidelity refers to the extent to which an intervention was implemented in clinical testing as it was conceptualized and is clearly differentiable from control or standard-of-care interventions. In clinical research, treatment fidelity is typically attained through intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters. However, in occupational and physical therapy outcomes research, treatment fidelity methods have not been used, which, in our view, is a serious gap that impedes novel treatment development and testing in these rehabilitation fields. In this article, we describe the development of methods to train and supervise therapists to attain adequate treatment fidelity in a treatment development project involving a novel occupational and physical therapy–based intervention. We also present a data-driven model for demonstrating therapist adherence and competence in the new treatment and its differentiation from standard of care. In doing so, we provide an approach that rehabilitation researchers can use to address treatment fidelity in occupational and physical therapy–based interventions. We recommend that all treatment researchers in rehabilitation disciplines use these or similar methods as a vital step in the development and testing of evidence-based rehabilitation interventions.

Assessing Executive Abilities Following Acute Stroke with the Trail Making Test and Digit Span

The Trail Making Test and Digit Span are neuropsychological tests widely used to assess executive abilities following stroke. The Trails B and Digits Backward conditions of these tests are thought to be more sensitive to executive impairment related to frontal lobe dysfunction than the Trails A and Digits Forward conditions. Trails B and Digits Backward are also thought to be more sensitive to brain damage in general. Data from the Stroke and Lesion Registry maintained by the Washington University Cognitive Rehabilitation Research Group were analyzed to compare the effects of frontal versus nonfrontal strokes and to assess the effects of stroke severity. Results showed that the performance of patients with frontal and nonfrontal strokes was comparable in each condition of both the Trail Making Test and Digit Span, providing no support for the widely held belief that Trails B and Digits Backward are more sensitive to frontal lobe damage. Further, Trails A was as strongly correlated with stroke severity as Trails B, whereas Digits Backward was more strongly correlated with stroke severity than Digits Forward. Overall, the Trail Making Test and Digit Span are sensitive to brain damage but do not differentiate between patients with frontal versus nonfrontal stroke.

Fulfilling the Promise: Supporting Participation in Daily Life

Participation is a central concept in rehabilitation, and by addressing it in science and practice, rehabilitation professionals and scientists provide a link between biomedical science and care and population health. This lecture traces the history of the development of participation and proposes language that includes, but expands, the International Classification of Functioning, Disability and Health language to foster communication of rehabilitation scientists. It also presents a model of rehabilitation service that focuses on participation that can be developed from evidence generated by rehabilitation scientists.

Multiple Errands Test-Revised (MET-R): A Performance-Based Measure of Executive Function in People With Mild Cerebrovascular Accident

OBJECTIVE. This article describes a performance-based measure of executive function, the Multiple Errands Test-Revised (MET-R), and examines its ability to discriminate between people with mild cerebrovascular accident (mCVA) and control participants. METHOD. We compared the MET-R scores and measures of CVA outcome of 25 participants 6 mo post-mCVA and 21 matched control participants. RESULTS. Participants with mCVA showed no to minimal impairment on measures of executive function at hospital discharge but reported difficulty with community integration at 6 mo. The MET-R discriminated between participants with and without mCVA (p ≤ .002). CONCLUSION. The MET-R is a valid and reliable measure of executive functions appropriate for the evaluation of clients with mild executive function deficits who need occupational therapy to fully participate in community living.