Emily Nalder

Reliability and construct validity of a revised Baycrest Multiple Errands Test

ABSTRACT Surprisingly few ecologically-valid assessments of executive function exist, but the Baycrest Multiple Errands Test (BMET) shows promise in identifying executive impairment. The goal of the present study was to develop both a revised version of the assessment (BMET-R), to improve the tests ability to discriminate between patients and healthy participants, and an alternate form of the BMET-R to permit repeat testing. Sixteen individuals with acquired brain injury (ABI) due to stroke or trauma and 16 healthy participants completed a series of neuropsychological assessments, questionnaires, the BMET-R and its alternate form (in counterbalanced order). The results of the study indicated that participants with ABI omitted more tasks, broke more rules, and were less efficient than healthy participants on both the revised BMET-R and its alternate form. Moreover, significant correlations were found between the two versions of the BMET-R for task completions, omissions, errors, rule breaks and inefficiencies but few significant correlations were observed between the BMET-R versions and measures of executive dysfunction in everyday life. These results indicate that the two versions of the BMET-R are able to dissociate the performance of participants with ABI from that of healthy participants. However, despite overlaps in performance and correlations between the two versions of the BMET-R, they did not identically assess executive deficits. This suggests that caution should be used when constructing and validating alternate versions of performance-based assessments.

Environmental control systems – the experiences of people with spinal cord injury and the implications for prescribers

Abstract Purpose: Environmental control systems (ECSs) can potentially influence comfort, safety, security and independence for people with severe impairment from spinal cord injury (SCI). This study, aimed at informing prescription practises, investigated ECS prescription and utilisation from the consumer perspective. Methods: Qualitative inquiry, through 15 semi-structured interviews, explored the perspectives of people with high level SCI who use ECSs. Data were coded and clustered to provide a description of their perspectives and interpret lessons for prescribers. Results: The data were grouped into six coding clusters related to readiness to engage, training, autonomy, utility, utilisation and attitudes towards the ECS. Data revealed variability in readiness to embrace ECSs during rehabilitation, some frustration related to setting up systems and instances of ECSs not being used to their full potential. Some highly motivated participants found reward through perseverance. All participants valued having some level of autonomy and personal security. Significant implications for prescribers are described. Conclusions: Understanding the influence of factors related to devices, personal characteristics and individual context on ECS usage can guide clinicians in prescription and training processes to facilitate maximum and ongoing benefit from ECSs. A culture of follow-up and evaluation is to be encouraged. Implications for Rehabilitation A variety of factors may influence whether a person with severe impairment from spinal cord injury fully utilises and persists with using an environmental control system (ECS). Findings from this study illustrate the importance of client readiness for prescription and the influence of client perceptions of value, convenience and aesthetics on ECS use. Prescribers should seek to understand what each client needs to become engaged and proficient with ECS use. Prescribers should be knowledgeable about suggested ECSs. Prescribers should prepare clients for potential difficulties in establishing reliable ECS use and establish support mechanisms to facilitate perseverance until effective ECS use is established.

Clinicians’ perceptions of the clinical utility of the Multiple Errands Test for adults with neurological conditions

This study examined the clinical utility of the Multiple Errands Test (MET) from the perspective of clinicians. Employing a qualitative descriptive design, in-depth semi-structured interviews were conducted with eight occupational therapists. Participants had an average of 12 years clinical experience and their experience using the MET varied. Interviews were transcribed and analysed using framework analysis. Three dominant themes emerged from the data. Theme 1 was that clinicians value the MET because it reflects real-life functioning. Clinicians perceived the MET to be a unique assessment collecting data on functional performance, and sensitive to higher level cognitive deficits. Theme 2 was that the MET could be used flexibly depending on ones rehabilitation goals. Clinicians employed the MET as an assessment to inform the direction of treatment and as a component of their intervention. Theme 3 was that the MET is a challenging assessment requiring buy in and commitment from therapists. This study is the first to report clinicians’ perspectives of the clinical utility of the MET. It reinforces the importance of ecologically valid tests, and augments existing research evaluating psychometric properties of the MET by describing how the MET has been employed in rehabilitation settings to improve health outcomes for adults with neurological conditions.

Loss of Financial Management Independence After Brain Injury: Survivors’ Experiences

OBJECTIVEnThis pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence.nnnMETHODnUsing a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis.nnnRESULTSnThree themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM.nnnCONCLUSIONnThis study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients experiences when supporting them through a change in independence.

Delivering cognitive behavioural interventions in an internet-based healthcare delivery environment:

Introduction This exploratory qualitative study assessed the feasibility of transitioning three face-to-face, cognitive behavioural interventions for adults with chronic health conditions to online delivery, by examining clinician and clients satisfaction with intervention training and delivery. Method The interventions adapted for online delivery were: ‘Managing Chronic Disease’, a programme for individuals who were nonadherent to prescribed rehabilitation regimens; ‘Real-World Strategy Training’, an occupation-based intervention for individuals with subjective cognitive decline; and ‘Learning the Ropes’, a memory programme for persons with mild cognitive impairment. Two occupational therapists and one nurse received training in, and then delivered one of the three interventions. Qualitative feedback interviews with participants, and archived video recordings of intervention sessions were analysed thematically. Results Key features of each manualised intervention were evident in the online sessions and perceived by clients as enhancing engagement (for example, peer support and strategy training). Clinicians felt that meeting individually with intervention experts was helpful to problem-solve technical issues and ensure adherence to protocols. Conclusion Three cognitive behavioural interventions transitioned to online delivery were acceptable to older adults and clinicians. A next step would be to complete randomised controlled trials investigating whether the interventions yield equivalent health benefits, using online and face-to-face delivery.

Therapists’ experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice

Abstract Background: The CO-OP ApproachTM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists’ perspectives on CO-OP may reveal insights into potential critical and mediating factors. Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation. Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (nu2009=u20093) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group. Results/Findings: Three themes were identified: ‘CO-OP works,’ ‘CO-OP delivery is mediated by contextual factors,’ and ‘CO-OP shifts the therapeutic approach.’ Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy. Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches. Significance: This is the first study to investigate CO-OP therapists’ experiences. Future research is recommended to enhance training of therapists in key CO-OP features.

Generating Expectations: What Pediatric Rehabilitation Can Learn From Mental Health Literature

ABSTRACT Family-Centered Care (FCC) represents the ideal service delivery approach in pediatric rehabilitation. Nonetheless, implementing FCC as intended in clinical settings continues to be hindered by knowledge gaps. One overlooked gap is our understanding of clients therapy expectations. This perspective article synthesizes knowledge from the mental health services literature on strategies recommended to service providers for generating transparent and congruent therapy expectations with clients, and applies this knowledge to the pediatric rehabilitation literature, where this topic has been researched significantly less, for the purpose of improving FCC implementation. Dimensions of the Measure of Processes of Care, an assessment tool that measures clients perceptions of the extent a service is family-centered, inform the organization of therapy expectation-generating strategies: (1) Providing Respectful and Supportive Care (assessing and validating clients expectations); (2) General and Specific Information (foreshadowing therapy journeys, explaining treatment rationale, and conveying service provider qualifications); (3) Coordinated and Comprehensive Care (socializing clients to roles and reflecting on past socialization); and (4) Enabling and Partnership (applying a negotiation framework and fostering spaces safe to critique). Strategies can help pediatric rehabilitation service providers work with families to reframe unrealistic expectations, establish congruent beliefs supporting effective partnerships, and prevent possible disillusionment with therapy over time.

Traumatic brain injury resiliency model: a conceptual model to guide rehabilitation research and practice

Abstract There is a growing trend in traumatic brain injury (TBI) rehabilitation, and research, to focus on the processes of adaptation following the injury. Resiliency is an umbrella term describing the range of personal protective factors, environmental supports and resources, as well as self-regulatory processes, engaged in response to adversity. An affective, cognitive, and behavioural self-regulatory process model of resiliency in the workplace was adapted to suit the TBI context. Through a narrative review of the literature pertaining to brain injury rehabilitation, participation, and resilience, we substantiated the model, and explained how resiliency can frame research on life experiences following the injury. TBI represents a cascading adversity as the injury and subsequent life experiences (e.g., job loss) shape adaptation. Resiliency is shaped by: personal characteristics (e.g., hope, social functioning, self-awareness, memory, spirituality, coping, and self-efficacy), environmental resources/supports (e.g., services and social support), and self-regulatory processes that lead to the resiliency-related outcomes, which we suggest involve re-engaging in activities, adapting participation, and reconstructing identity. This conceptual model outlines and defines the factors and processes operating and contributing to resiliency following TBI. Recommendations for future research are outlined. Implications for rehabilitation Investigating resiliency processes can move the traumatic brain injury field beyond examining individual traits and protective factors, to transactional processes that influence participation experiences and opportunities over time. The Traumatic Brain Injury Resiliency Model can be used to frame the targets and desired outcomes of rehabilitation interventions, such as self-regulatory processes or environmental supports known to enhance resiliency. Studying resiliency will help to shift the paradigms of traumatic brain injury research, and rehabilitation practice, to a focus on life experiences and adaptation, helping individuals, clinicians, and families consider processes of positive change, rather than focusing solely on adversity.

Sex and gender differences in caregiving burden experienced by family caregivers of persons with dementia: a systematic review protocol

Introduction While much is known about caregiving burden and its consequences on both caregivers and care recipients, reports on the sex and gender differences that may be present among family caregivers of persons with dementia (PWD) are lacking. Attention to and a synthesis of these sex and gender distinctions have direct implications on the planning and development of health services for this population. The current protocol outlines a strategy for a systematic review of the current evidence to identify and synthesise sex and gender distinctions in caregiving burden experienced by family caregivers of PWD. Methods and analysis A comprehensive search strategy for studies that examine the sex and gender differences in caregiving impacts and experiences has been developed in collaboration with an information specialist at a university. All peer-reviewed English language studies on adult family caregivers of PWD, published from January 2007 to September 2017, found through Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and bibliographies of identified articles, will be considered eligible. Study quality will be assessed using the Critical Appraisal Skills Programme checklists. Ethics and dissemination As the first systematic review of its kind that focus on sex and gender differences in caregiving burden, findings will be relevant for healthcare practitioners and researchers who can better prescribe and develop interventions and technologies to better address the specific challenges and burden experienced by male and female family caregivers of PWD. Moreover, given that more than half of family caregivers are females; these sex and gender differences will also be pertinent to policy-makers when evaluating and planning of our healthcare systems to better meet the needs of this population. Trial registration number CRD42018070032.

Bridging knowledge, policies and practices across the ageing and disability fields: a protocol for a scoping review to inform the development of a taxonomy

Introduction Bridging is a term used to describe activities, or tasks, used to promote collaboration and knowledge exchange across fields. This paper reports the protocol for a scoping review which aims to identify and characterise peer reviewed evidence describing bridging activities, between the ageing and disability fields. The purpose is to clarify the concepts underpinning bridging to inform the development of a taxonomy, and identify research strengths and gaps. Methods A scoping review will be conducted. We will search Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycInfo, Sociological Abstracts and the Cochrane Library, to identify peer reviewed publications (reviews, experimental, observational, qualitative designs and expert commentaries) describing bridging activities. Grey literature, and articles not published in English will be excluded. Two investigators will independently complete article selection and data abstraction to minimise bias. A data extraction form will be iteratively developed and information from each publication will be extracted: (1) bibliographic, (2) methodological, (3) demographic, and (4) bridging information. Qualitative content analysis will be used to describe key concepts related to bridging. Conclusions To our knowledge, this will be the first scoping review to describe bridging of ageing and disability knowledge, services and policies. The findings will inform the development of a taxonomy to define models of bridging that can be implemented and further evaluated to enable integrated care and improve systems and services for those ageing with disability. Ethics and dissemination Ethics is not required because this is a scoping review of published literature. Findings will be disseminated through stakeholder meetings, conference presentations and peer reviewed publication.