Diane MacKenzie

Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review

Mild traumatic brain injury (mTBI), or concussion, is the most common type of traumatic brain injury. With mTBI comes symptoms that include headaches, fatigue, depression, anxiety and irritability, as well as impaired cognitive function. Symptom resolution is thought to occur within 3 months post-injury, with the exception of a small percentage of individuals who are said to experience persistent post-concussion syndrome. The number of individuals who experience persistent symptoms appears to be low despite clear evidence of longer-term pathophysiological changes resulting from mTBI. In light of the incongruency between these longer-term changes in brain pathology and the number of individuals with longer-term mTBI-related symptoms, particularly impaired cognitive function, we performed a scoping review of the literature that behaviourally assessed short- and long-term cognitive function in individuals with a single mTBI, with the goal of identifying the impact of a single concussion on cognitive function in the chronic stage post-injury. CINAHL, Embase, and Medline/Ovid were searched July 2015 for studies related to concussion and cognitive impairment. Data relating to the presence/absence of cognitive impairment were extracted from 45 studies meeting our inclusion criteria. Results indicate that, in contrast to the prevailing view that most symptoms of concussion are resolved within 3 months post-injury, approximately half of individuals with a single mTBI demonstrate long-term cognitive impairment. Study limitations notwithstanding, these findings highlight the need to carefully examine the long-term implications of a single mTBI.

Occupational Therapists and Observation: What are You Looking At?

Visual observation is a fundamental skill underlying all occupational performance assessments in occupational therapy. The purpose of this study was to determine whether eye movement patterns differ between occupational therapists and non-healthcare professionals during observation of static images portraying a client post-stroke (domain-specific content) or naturalistic scenes (domain-irrelevant content). Ten licensed occupational therapists (OT group) and 10 participants matched for age, gender, and education level (NonOT group) completed the study. Participants viewed two counterbalanced blocks of 10 images (scene and stroke) under the pretext of preparing for a memory test. The OT group differed in the viewing strategies during observation and in how they directed their eyes (higher frequency of fixations, shorter fixation durations, and increased saccade count) for domain-specific and domain-irrelevant images alike. Observation patterns used by occupational therapists are presumably related to top-down influences that are not necessarily related to domain-specific knowledge but perhaps to general experience with performing assessments using observational methods.

Collaboration behind-the-scenes: key to effective interprofessional education

Abstract A variety of stakeholders, including students, faculty, educational institutions and the broader health care and social service communities, work behind-the-scenes to support interprofessional education initiatives. While program designers are faced with multiple challenges associated with implementing and sustaining such programs, little has been written about how program designers practice the interprofessional competencies that are expected of students. This brief report describes the backstage collaboration underpinning the Dalhousie Health Mentors Program, a large and complex pre-licensure interprofessional experience connecting student teams with community volunteer mentors who have chronic conditions to learn about interprofessional collaboration and patient/client-centered care. Based on our experiences, we suggest that just as students are required to reflect on collaborative processes, interprofessional program designers should examine the ways in which they work together and take into consideration the impact this has on the delivery of the educational experience.

Observation patterns of dynamic occupational performance.

Background Visual observation is a key component of both formal and informal occupational performance assessment, but it is unknown how therapists gather this visual information. Purpose The purpose of this study was to explore observational behaviour of occupational therapists and non–health care professionals when watching videos of simulated clients post-stroke participating in everyday activity. Method Ten licensed occupational therapists and 10 age-, gender-, and education level–matched participants completed this eye-tracking study. Findings Contrary to our past work with static image viewing, we found limited evidence of differences in eye movement characteristics between the two groups, although results did support the role of bottom-up information, such as visual motion, as a determinant of looking behaviour. Implications These results suggest that understanding observational behaviour in therapists can be aided with eye-tracking methodology, but future studies should probe a broad range of factors that might influence observational behaviour and performance, such as assessment goals, knowledge, and therapist experience. Description L’observation visuelle est un élément clé de l’évaluation formelle et informelle du rendement occupationnel, mais on ne sait pas comment les ergothérapeutes recueillent cette information visuelle. But Le but de cette étude était d’examiner les comportements d’observation d’ergothérapeutes et de professionnels n’étant pas du domaine de la santé pendant qu’ils regardaient des vidéos représentant des clients post-AVC simulés participant à des activités de la vie quotidienne. Méthodologie Dix ergothérapeutes agréés et dix participants jumelés à ces ergothérapeutes en fonction de leur âge, leur sexe et leur degré d’éducation ont participé à cette étude oculométrique. Résultats Contrairement à nos travaux antérieurs sur le visionnement d’images fixes, nous avons trouvé peu de données probantes permettant d’établir des différences entre les deux groupes face aux caractéristiques des mouvements des yeux, bien que les résultats indiquent que l’information ascendante (perceptive), comme les mouvements visuels, joue un rôle a en tant que déterminant du comportement d’observation. Conséquences Ces résultats suggèrent que la méthodologie de l’oculométrie peut permettre de mieux comprendre les comportements d’observation des ergothérapeutes, mais il faudra effectuer d’autres études en vue d’examiner un large éventail de facteurs susceptibles d’influencer les comportements d’observation et le rendement, notamment, les objectifs de l’évaluation, les connaissances et l’expérience de l’ergothérapeute.

Allen Cognitive Level Screen for the classification of subjects treated for addiction

Abstract Introduction The Cognitive Disabilities Model (CDM) is an occupational approach that can allow the classification of the functional-cognitive abilities of persons with addictions. The objective of the study was to explore the applicability of the ACLS-5 to assess a sample of persons undergoing addiction-rehabilitation treatment. Methods A sample of 232 participants was recruited from an outpatient treatment centre in Madrid (Spain). The ACLS-5, the Montreal Cognitive Assessment (MoCA), and the Prefrontal Symptom Inventory (PSI) were administered. Sociodemographic and addiction-related data were also obtained. Results Half of the sample showed serious deficits in functional cognition, which ultimately could be related to problems in their daily performance. Scores of ACLS-5 showed significant correlations with the severity of addiction, with those obtained with the MoCA, and with attentional symptoms on the PSI scale. Conclusions The data suggest the applicability of the ACLS-5 in assessing the degree of functional cognition in subjects treated for addiction, providing evidence to support ecological validity and facilitating the development of well-targeted cognitive rehabilitation programmes from an occupational perspective. The use of occupational-based instruments to assess the functioning of those with addictions is a requirement of occupational therapy professionals working in this general area.

Best practice interprofessional stroke care collaboration and simulation: The student perspective

ABSTRACT Interprofessional practice (IPP) is the accepted standard of care for clients following a stroke. A brief, embedded and evidence-based IPP team simulation was designed to address stroke care knowledge and IPP competencies for students within limited curriculum space. Each team was required to construct a collaborative care plan for their patient during the simulation and submit the care plan for evaluation of best practice stroke care knowledge and implementation with evidence of interprofessional collaboration (IPC). A total of 302 students (274 on-site, 28 by distance technology) representing four professions comprised of 55 teams took part in this experience. Post-simulation, voluntary and anonymous programme evaluations were completed using the standardised interprofessional collaborative competency assessment scale (ICCAS) and open-ended free-text responses to five questions. There was a significant improvement for all pre–post ratings on the ICCAS regardless of profession or previous interprofessional experience. Additionally, the open-ended responses indicated perceived changes to role clarification, communication, and teamwork. The combined interpretation of the programme evaluation results supports interprofessional team simulation as an effective and efficient learning experience for students regardless of previous interprofessional experience, and demonstrated positive changes in stroke best-practice knowledge and IPC competencies.

Scoping review of the Multiple Errands Test: Is it relevant to youths with acquired brain injury?

Introduction For youths who sustain acquired brain injuries, distinguishing typical development of executive function from the impairment(s) can be a challenging but critical assessment consideration. Occupational therapists working with individuals after brain injury can use the Multiple Errands Test as a performance-based assessment of the effect of executive dysfunction in the real world. Although numerous test versions exist for different settings and diagnostic populations, their relevance to youths is unclear. We surveyed the non-virtual reality literature for test versions to determine the measurement properties and clinical utility for assessing youths in a community setting. Method A scoping review was completed to summarize study purpose/design, Multiple Errands Test structure, assessment environment, sample characteristics, psychometric properties, clinical utility and main findings of the test versions. Results We included 10 quantitative studies and found the strongest reliability and validity evidence for male adults with moderate to severe acquired brain injury, in a hospital setting. Multiple Errands Test versions can distinguish people with brain injury from controls and identify challenges in the home and community. No studies examined the test performance of younger participants. Conclusion This review highlights the research of several Multiple Errands Test versions and identifies gaps in that research, including the need for development of a test version for youths in a community setting.

Complex Trauma in Children and Youth: A Scoping Review of Sensory-Based Interventions

ABSTRACT Emerging evidence in neuroscience indicates exposure to complex trauma in children and youth affects brain development—particularly with the ability to process sensory information. This sensory processing challenge has been shown to negatively impact emotional and self-regulation. A developing area of trauma treatment utilizes sensory-based interventions to target these concerns. A scoping review of the literature indicates there is limited, although promising, evidence for the use of these interventions when used as part of an integrated treatment approach. Occupational therapy is in a unique position to contribute to this area of practice due to a background in sensory-based approaches.

Investigating visual attention during scene perception of safe and unsafe occupational performance

Background. Occupational therapists routinely use observation for evaluation, intervention planning, and prediction of a client’s occupational performance and/or safety within the environment. Perception of safety contributes to the decision-making process for discharge or placement recommendations. Purpose. The purpose of this study was to determine if differences exist in safety ratings and eye movements between occupational therapists and nontrained matched individuals while viewing domain-specific versus non-domain-specific images. Method. Ten licensed occupational therapists and 10 age-, gender-, and education level–matched participants completed this eye-tracking study. Findings. For all image exposure durations, occupational therapists had more polarized safety ratings for stroke-related image content but little evidence of differences in eye movements between groups. Eye movement group differences did not emerge in the regions of interest identified by an independent expert panel. Implications. The results point to a complex relationship between decision making and observational behaviour in occupational assessment and highlight the need to look beyond image features.