Glen Gillen

Effect of Imagery Perspective on Occupational Performance After Stroke: A Randomized Controlled Trial

OBJECTIVE This preliminary study sought to determine whether the imagery perspective used during mental practice (MP) differentially influenced performance outcomes after stroke. METHOD Nineteen participants with unilateral subacute stroke (9 men and 10 women, ages 28-77) were randomly allocated to one of three groups. All groups received 30-min occupational therapy sessions 2×/wk for 6 wk. Experimental groups received MP training in functional tasks using either an internal or an external perspective; the control group received relaxation imagery training. Participants were pre- and posttested using the Fugl-Meyer Motor Assessment (FMA), the Jebsen-Taylor Test of Hand Function (JTTHF), and the Canadian Occupational Performance Measure (COPM). RESULTS At posttest, the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF (p < .05). All groups improved on the COPM (p < .05). CONCLUSION MP combined with occupational therapy improves upper-extremity recovery after stroke. MP does not appear to enhance self-perception of performance. This preliminary study suggests that imagery perspective may not be an important variable in MP interventions.

A Fork in the Road: An Occupational Hazard?

Glen Gillen, EdD, OTR, FAOTA, is Associate Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University, 710 West 168th Street, 8th Floor, New York, NY 10032; GG50@Columbia.edu Gillen, G. (2013). A fork in the road: An occupational hazard? (Eleanor Clarke Slagle Lecture). American Journal of Occupational Therapy, 67, 641–652. http://dx.doi.org/10.5014/ajot.2013.676002

A Comparison of Time Use on an Acute Rehabilitation Unit: Subjects With and Without a Stroke

This study describes the time use of subjects on a mixed diagnosis inpatient rehabilitation unit. Twelve subjects were observed during two days: one weekday and one weekend day for 8 hours each observational day. Seven subjects had sustained a stroke (CVA) and 5 subjects had other diagnoses (non-CVA). The observers used the behavioral mapping technique to obtain an objective description of the subjects time use and the admission, discharge, and efficiency scores of the Functional Independence Measure (FIM) to obtain a measure of functional activity level. During the weekday observations, the subjects who had a stroke spent more time inactive, 25.0%, as compared to the subjects who had other diagnoses, 15.0%. In addition, the subjects who had a stroke spent more time alone, 53.6%, while the other subjects spent 38.8% time alone. While both amounts of inactivity and time alone increased during the weekend observation, the pattern remained the same. All FIM measures were lower for the subjects who had a stroke as compared to subjects who had other diagnoses. It appears that those who are recovering from a stroke show a discrepancy in self-directed activity level from those who did not have a stroke, while hospitalized on the same unit.

A pilot study of robotic-assisted exercise for hand weakness after stroke

Upper limb paresis is a major source of disability in stroke survivors, and robotic aided exercise therapy is a promising approach to enhance motor abilities. Few devices have been available to provide robotic therapy to the fingers and hand. We report an open-label pilot study of 12 individuals with chronic moderate hemiparesis after stroke who underwent a six-week training program using a hand robotic device. Participants received a total of 18 hours of robotic therapy. Improvements were found in multiple measures of motor performance, including the Upper Extremity Fugl-Meyer, the Motor Activity Log, the Manual Ability Measure-36, and the Jebsen Hand Function Test. All subjects tolerated the treatment well and no complications were observed. We conclude that robotic therapy for hand paresis after stroke is safe and feasible, and that further studies of efficacy are justified by these preliminary results.

Robot-assisted exercise for hand weakness after stroke: a pilot study.

Objective: Upper-limb paresis is a major source of disability in stroke survivors, and robotic device-aided exercise therapy is a promising approach to enhance motor abilities. Few robotic devices have been available to provide therapy to the fingers and hand. This study was designed to test a new robotic device for hand rehabilitation in stroke survivors. Design: This is an open-label pilot study of 12 individuals with chronic moderate hemiparesis after stroke. Participants underwent a 6-wk training program using a hand robotic device. Participants received a total of 18 hrs of robotic therapy. Results: Improvements were found in multiple measures of motor performance, including the Upper Extremity Fugl-Meyer test, the Motor Activity Log, the Manual Ability Measure-36, and the Jebsen Hand Function Test. All subjects tolerated the treatment well and no complications were observed. Conclusions: Robotic therapy for hand paresis after stroke is safe and feasible, and further studies of efficacy are justified by these preliminary results.

Ensuring that education, certification, and practice are evidence based.

The occupational therapy profession has put forth a vision for evidence-based practice. Although many practitioners express a commitment to the provision of services informed by evidence, the reality that tradition still determines much of our education, certification, and practice cannot be ignored. In this article, we highlight the disconnect between the professions aspirations and actual practices using neurophysiological models as an example. We describe actions to actualize the shift from traditional interventions to evidence-based approaches. We challenge readers to become agents of change and facilitate a culture shift to a profession informed by evidence. It is our hope that this article will provoke critical discourse among educators, practitioners, authors, and editors about why a reluctance to let go of unsubstantiated traditions and a hesitancy to embrace scientific evidence exist. A shift to providing evidence-based occupational therapy will enable us to meet the objectives of the Centennial Vision.

Trunk Posture Affects Upper Extremity Function of Adults

This study examined the effects of various seated trunk postures on upper extremity function. 59 adults were tested using the Jebsen Taylor Hand Function Test while in three different trunk postures. Significant mean differences between the neutral versus the flexed and laterally flexed trunk postures were noted during selected tasks. Specifically, dominant hand performance during the tasks of feeding and lifting heavy cans was significantly slower while the trunk was flexed and laterally flexed than when performed in the neutral trunk position. Performance of the nondominant hand during the tasks of picking up small objects, page turning, as well as the total score was slower while the trunk was flexed compared to performance in the neutral trunk position. These findings support the assumption that neutral trunk posture improves upper extremity performance during daily activities although the effect is not consistent across tasks. Findings are discussed along with limitations and recommendations for research.

Improving Community Skills After Lower Extremity Joint Replacement

The purpose of this study was to examine the effect of an occupational therapy intervention focused on improving community skills after a lower extremity major joint replacement. One hundred and seven subjects, status-post total hip or total knee replacement, were examined pre- and post-community reintegration intervention involving practice of community skills in a natural environment. Participants reported significantly higher scores post-intervention on measures of satisfaction with performance, performance, and confidence (p < .0001) related to community living skills. Self-reported scores were significantly higher for individual community skills as well as the overall score (p < .0001). Limitations and recommendations for future research are discussed.

Chapter 5 – Managing Apraxia to Optimize Function

A praxia is defined as a disorder of purposeful skilled movement that cannot be attributed to sensorimotor dysfunction (i.e., weakness, tremor, spasticity, loss of joint position sense) or comprehension deficits. 34 While apraxia is the impairment, it refers to a loss of the skill known as praxis. Characteristics of the praxis system include the following 42 : 1 . It is most often lateralized to the left hemi sphere. 2 . It serves to store skilled motor information for future use. 3 . It facilitates interaction with environment. 4 . It provides a processing advantage so that new planning is not required each time an activity is started. 5 . It can be described by a two-step process that results in execution of a purposeful activity 2,4,5,42 : (1) Conceptual/ideation: provides information related to the overall concept and purpose of the task, information related to what to do, an overall plan to engage in the task, sequence of actions, and knowledge related to tool use. If an adult person without neurologic impairment is placed in front of a meal tray that person has an understanding of the purpose and goal of the task, understands which utensils to choose, understands how to use them, and can sequence the steps of the task to completion. (2) Production/planning: refers to knowing how C H A P T E R 5

Mobility: Examining the Impact of the Environment on Transfer Performance

Objective. The purpose of this study was to measure and compare transfer performance of individuals with a central nervous system (CNS) disorder within two varying environments. The two environmental conditions were a traditional clinic setting, and a more naturalistic simulated apartment. Method. This study included 25 participants undergoing inpatient rehabilitation for a CNS disorder. Each participant (N = 25) performed four transfer tasks (100 transfers in total); two bedside commode transfers (one in each environment) and two bed-to-chair transfers (one in each environment). The Functional Independence Measure (FIM) was used to measure the level of independence in transfers. Results. Forty-four percent (44%) of the participants performed better in the clinic setting. Twenty percent (20%) performed better in the simulated apartment. Analysis of FIM data revealed that 36% of the participants transferred consistently in both environments. However, overall 64% of the participants were inconsistent in the same transfer task across the two environments. Conclusion. This research supports the concept that the environment impacts functional performance. Performance of activities of daily living and functional mobility tasks such as transfers may differ across various environmental contexts.