Christine Chapparo

Agitation following traumatic brain injury: An Australian sample

Purpose: Agitation following traumatic brain injury (TBI) is perceived to limit the achievement of rehabilitation goals. The aims of this study were: (1) To examine the nature and incidence of agitation during TBI rehabilitation in an Australian sample; and (2) To explore the relationship between agitation and functional outcomes after TBI. Method: Retrospective medical record review of 80 participants admitted for rehabilitation following TBI. Outcome data collected at discharge, 6 and 24 months post-discharge, included length of stay, duration of post-traumatic amnesia (PTA), community integration, functional independence and life satisfaction. Results: Seventy per cent of patients demonstrated agitation during rehabilitation for an average of 32 days. Agitated patients experienced longer PTA duration, increased length of stay and reduced functional independence, specifically cognitive function, at discharge. These differences between agitated and non-agitated participants did not appear to persist and were not evident at follow-up 6 and 24 months post-discharge. Longer duration of agitation was associated with delayed PTA emergence, longer rehabilitation stay and reduced functional independence at discharge and follow-up. Conclusions: A large proportion of patients with TBI experience agitation. Presence of agitation seems to limit rehabilitation gains at discharge. Longer duration of agitation is associated with persisting limitations to functional independence.

Reliability of the Perceive, Recall, Plan and Perform System of Task Analysis: A criterion‐referenced assessment

OBJECTIVE To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury. METHODS Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency. RESULTS Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion (-4.5%; 95% confidence interval for: -10.67% → 3.17%). CONCLUSION The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury.

Effective occupational therapy intervention with adults demonstrating agitation during post-traumatic amnesia

Objective: To investigate the effectiveness of occupational therapy (OT) with adults demonstrating agitation and post-traumatic amnesia (PTA) following brain injury. Design: Single-system experimental design (ABAB) across subjects. Methods: Eight subjects were recruited during acute rehabilitation. Current OT intervention was alternated with the experimental Perceive, Recall, Plan and Perform (PRPP) System approach over 4-weeks. Therapy was conducted daily. Information processing capacity during occupational tasks was measured using the PRPP System of Task Analysis. PTA status was monitored with the Westmead PTA Scale. Experimental intervention: The PRPP System is a dynamic assessment and intervention approach that directly links results of cognitive task analysis with strategies for intervention. PRPP Intervention adopts an information processing approach that simultaneously focuses on task training, strategy training and strategy application within occupational performance. Results: Seven subjects significantly improved in their application of processing strategies during the PRPP Intervention in comparison to current OT Intervention phases. Large treatment effects favoured the PRPP Intervention. Subjects demonstrated improved information processing strategy use both prior to and following emergence from PTA. Conclusions: Occupational therapy intervention based upon the PRPP System of Task Analysis and Intervention improved subjects’ ability to apply information processing strategies during occupational performance when compared to current intervention approaches.

Use of the Perceive, Recall, Plan and Perform System of Task Analysis for persons with schizophrenia: a preliminary study.

BACKGROUND/AIM Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for this clientele. The specific objectives were to describe information processing difficulties as measured by the PRPP and to examine preliminary evidence of construct validity and interrater reliability. METHODS In the first part of this study, 10 participants with schizophrenia living in the community were assessed using the PRPP during both a simple and a complex meal preparation task. Community functioning was measured using the Independent Living Skills Survey. In the second part, interrater reliability was appraised using three trained raters, who scored 15 participants preparing the complex meal preparation task. RESULTS Analysis of performance demonstrates that people with schizophrenia have difficulties especially in the Perceive and Plan quadrants of the PRPP and are more challenged in the complex task. The PRPP total score for the complex task is strongly related to the community functioning score. Results indicate good interrater reliability for the PRPP total score and moderate interrater reliability for the quadrant scores. CONCLUSION  Despite the small sample size, results from this preliminary study support the use of the PRPP System of Task Analysis to further explore the impact cognitive deficits have on daily task performance and thus on community functioning in people with schizophrenia.

Social competence and learning difficulties: Teacher perceptions

BACKGROUND/AIM Social competence has been linked to childrens classroom performance with three out of four children with learning difficulties reported to have problems with social skills. Social participation remains a predominant childhood occupation and a key indicator of school performance. Occupational therapists work with teachers to accurately assess the social performance of children in context and to provide targeted intervention. There is limited research about what teachers perceive are the specific nature of social difficulties experienced by children with learning difficulties in the classroom. This study investigated teacher perceptions of the social competence of a small sample of Australian boys with learning difficulties within the classroom context. METHODS The Teacher Skillstreaming Checklist was used to investigate teacher perceptions of the social abilities of 21 primary school aged boys with learning difficulties compared to a control group. A correlational analysis was used to examine the relationship. RESULTS AND CONCLUSIONS The study identified that the boys with learning difficulties were perceived by their teachers as having poorer social performance across multiple domains when compared to their typically developing peers. Implications of these findings are that childrens social performance may negatively impact learning and classroom participation and that for some children, social competence should be a focus of occupational therapy assessment and treatment.

Difficulties with multitasking on return to work after TBI: a critical case study

Work performance research highlights that psychometric cognitive measures and cognitive component information processing measures are strong predictors of success in multitasking work environments [14]. People with a mild to moderate traumatic brain injury (TBI) returning to a job requiring multitasking, may have difficulty succeeding despite pre-morbid equivalent cognitive scores. A critical case study is presented to begin to determine what aspects of information processing contribute to difficulties in multitasking work performance, for people with a TBI. The Perceive Recall Plan and Perform (PRPP) System of Task Analysis: Workplace Interview (i.e. PRPP@WORK) is used with the employer to obtain information processing scores. Results indicate substantial information processing deficits were perceived by the employer for the employee with a TBI. Future larger studies of people with a TBI who return to work that requires multitasking are needed to more clearly indicate: the level of multitasking they perform; what aspects of information processing hinder their work performance; the impact on performance of perceived cognitive load by the person with a TBI and the type and impact of support provided to improve their work performance.

Patterns of agitated behaviour during acute brain injury rehabilitation.

Objective: To monitor daily shift-by-shift changes in agitated behaviour during adult brain injury rehabilitation. Design: A prospective, descriptive study. Methods: Eight participants were monitored daily for up to 28 days. The Agitated Behaviour Scale (ABS) evaluated behaviour during three nursing shifts (morning, afternoon, night). Severity of agitation, peak intensity and concomitant behaviours were calculated. Shift differences and patterns of behavioural changes were analysed. Results: Four hundred and seven recordings were taken with the ABS. All participants demonstrated multiple agitated behaviours (between 3–13 concomitant behaviours per person); the most common behaviours were representative of the ABS Disinhibition sub-scale. Weekly peak intensity ranged from 14–55 on the ABS. Mean ABS scores were highest during the afternoon shift and lowest at night. Improved cognition was associated with resolving agitated behaviour; while persistent agitated behaviour was associated with low levels of cognition. Minimal agitated behaviour was observed in participants who emerged from post-traumatic amnesia. Conclusions: Agitated behaviour during acute brain injury rehabilitation has a complex clinical presentation. High levels of agitation observed during the afternoon shift may be associated with low levels of structured activities available at that time, higher levels of environmental stimuli during visiting times and increased cognitive fatigue. Lower cognitive ability was related to consistently higher levels of agitated behaviour and vice-versa.

An Investigation of Occupational Role Performance in Men over Sixty Years of Age, Following a Stroke.

Abstract Life roles can be seen as social, cultural and occupational roles. Occupational roles are patterns of self maintenance, work, leisure and rest activities that are done on a regular basis and are strongly associated with social cultural roles. Occupational role performance is the way that activities linked to these roles are carried out. It is proposed that occupational role performance has a direct relationship to lifestyle and health issues. Very little is known about the occupational roles of the elderly, and nothing is known about the way elderly people who have had a stroke organise their daily activities following discharge from rehabilitation programs. The purpose of this study was to gather information about the self‐perceived occupational role performance profiles of elderly men who have had a stroke and are living at home. This information will be utilised in subsequent research into factors that influence occupational role performance in the elderly. Although role assessment instruments...

Daily Functioning and Information-Processing Skills Among Persons With Schizophrenia

OBJECTIVES This study aimed to describe the limitations in information-processing skills observed among persons with schizophrenia performing daily tasks and to explore whether subgroups of participants have similar profiles based on these functional limitations. METHODS Eighty-two participants with schizophrenia living in the community were assessed during their performance of a daily activity (meal preparation). Measures included a performance-based assessment for evaluating information-processing skills-the Perceive, Recall, Plan, and Perform System of Task Analysis-community functioning and symptom assessments, and neuropsychological tests from the Cambridge Neuropsychological Test Automated Battery. Research participants were classified as having high efficiency or low efficiency according to their score on the performance-based assessment and were compared on the functional, cognitive, and symptoms variables. RESULTS Participants committed various errors, and functional limitations, namely problematic information-processing skills in the perceive, recall, and plan quadrants, were observed during the daily task performance. Participants from the high-efficiency group were more independent in their living skills and more successful in attaining residential independence compared with participants from the low-efficiency group. The only cognitive test that differentiated both groups was the visuospatial associative learning test. No differences were found in the severity of symptoms. CONCLUSIONS Findings suggest that both performance in a daily task and memory-and specifically associative learning capacity-provide key information for the level of residential independence. Interventions aiming for the efficient use of information-processing skills during daily tasks among persons with schizophrenia should be carried out accordingly.

Measuring information processing in a client with extreme agitation following traumatic brain injury using the Perceive, Recall, Plan and Perform System of Task Analysis

BACKGROUND/AIMS Agitation following traumatic brain injury is characterised by a heightened state of activity with disorganised information processing that interferes with learning and achieving functional goals. This study aimed to identify information processing problems during task performance of a severely agitated adult using the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis. Second, this study aimed to examine the sensitivity of the PRPP System to changes in task performance over a short period of rehabilitation, and third, to evaluate the guidance provided by the PRPP in directing intervention. METHODS A case study research design was employed. The PRPP System of Task Analysis was used to assess changes in task embedded information processing capacity during occupational therapy intervention with a severely agitated adult in a rehabilitation context. Performance is assessed on three selected tasks over a one-month period. RESULTS Information processing difficulties during task performance can be clearly identified when observing a severely agitated adult following a traumatic brain injury. Processing skills involving attention, sensory processing and planning were most affected at this stage of rehabilitation. These processing difficulties are linked to established descriptions of agitated behaviour. Fluctuations in performance across three tasks of differing processing complexity were evident, leading to hypothesised relationships between task complexity, environment and novelty with information processing errors. Changes in specific information processing capacity over time were evident based on repeated measures using the PRPP System of Task Analysis. This lends preliminary support for its utility as an outcome measure, and raises hypotheses about the type of therapy required to enhance information processing in people with severe agitation. CONCLUSIONS The PRPP System is sensitive to information processing changes in severely agitated adults when used to reassess performance over short intervals and can provide direct guidance to occupational therapy intervention to improve task embedded information processing by categorising errors under four stages of an information processing model: Perceive, Recall, Plan and Perform.