Jim Hinojosa

Comparison of remedial and compensatory interventions for adults with acquired brain injuries

OBJECTIVE To examine the effects of a compensatory intervention versus a remedial intervention for deficits in visual processing of adults with acquired brain injuries (ABI). SETTING A cognitive rehabilitation program at a large comprehensive rehabilitation hospital in the New York City metropolitan area. PATIENTS Thirty adults with ABI were matched according to severity of injury, gender, age, and time post-injury, and randomly assigned to the remedial or compensatory group. INTERVENTIONS The remedial intervention consisted of four 45-minute sessions (once weekly) of participation in computer tasks without instruction in compensatory strategies. The compensatory intervention consisted of four 45-minute sessions of instruction in the use of three internal compensatory strategies, including verbalization, chunking, and pacing. MAIN OUTCOME MEASURES Pretest/posttest measures included three functional computer tasks. Weekly measures included a computerized version of the Paced Auditory Serial Addition Task (PASAT) and two computerized matching tasks. RESULTS Both groups exhibited statistically significant improvement of comparable degree on posttests and weekly measures. Further analysis revealed that 80% of both groups used compensatory strategies, regardless of intervention method. Those who used strategies demonstrated better performance than those who did not. CONCLUSION The ability to use internal compensatory strategies may be a significant confound in research examining the effects of the various cognitive rehabilitation intervention methods.

Assessing handwriting intervention effectiveness in elementary school students: a two-group controlled study.

This study examined the effectiveness of two approaches used in elementary schools to improve childrens handwriting. Participants were 72 New York City public school students from the first and second grades. A nonequivalent pretest-posttest group design was used in which students engaged in handwriting activities using two approaches: intensive handwriting practice and visual-perceptual-motor activities. Handwriting speed, legibility, and visual-motor skills were examined after a 12-wk Handwriting Club using multivariate analysis of variance. The results showed that students in the intensive handwriting practice group demonstrated significant improvements in handwriting legibility compared with students in the visual-perceptual-motor activity group. No significant effects in handwriting speed and visual-motor skills were found between the students in intensive handwriting practice group and the students in visual-perceptual-motor activities group. The Handwriting Club model is a natural intervention that fits easily into existing school curriculums and can be an effective short-term intervention (response to intervention Tier II).

Team Collaboration: A Case Study of an Early Intervention Team

The study described in this article sought to examine the workings of an interdisciplinary team as a research entity and as a service provider. There were two levels of analysis in the study: the process of collaborating on the research and the results of the research observation of an interdisciplinary team in a clinical setting. An interdisciplinary research team studied the interaction of a single clinical team over a 6-month period working with one child in a hospital-based early intervention program. The data were collected through intensive interviews, direct observations of the family and team members, and selected videotaping of team meetings. Qualitative data analysis methods were used, and five themes emerged: who takes the lead, the classroom as a way station, we like our freedom but..., who is giving and who is taking advice, and communication comes in few forms.

The evidence-based paradox.

Many occupational therapy practitioners consider evidence-based practice (EBP) to be the means by which occupational therapy can prove the validity of its services and thus support the legitimacy of our profession. The unquestioned acceptance of EBP as the way to establish credibility concerns me; unchallenged acceptance of any idea concerns me. Do practitioners accept EBP as the paradigm for guiding occupational therapy practice and research solely because it is presented as what we must do? I believe that practitioners must examine the implications for our profession of accepting EBP without question. In this article, I review EBP, present criticisms and concerns voiced by other professions and, finally, examine the implications of adopting an EBP perspective that replaces theory-directed practice.

Reconsidering Insider Status for Families During the Transition From Early Intervention to Preschool Special Education

Scholars know little about families’ experiences when receiving related services and how these services affect the shift from a family-centered to an educational program. In this qualitative interview study, the authors explored the transition experiences of six families over a 3-month period, focusing on the role of related therapy services and therapists. In the metatheme titled The Outsiders, the authors discuss these families’ views of their changing roles as their children enter preschool programs. Families in this study felt removed from their former role as an integral member of their children’s intervention team once their children entered school. Based on these families’ reported experiences, the authors propose strategies for professionals to improve their communication with parents to help them during this transition.

Relationships between Therapists and Parents of Preschool Children with Cerebral Palsy: A Survey

This survey investigated the roles of occupational therapists working with parents of preschool children with cerebral palsy. It examined and identified (a) attitudes of occupational therapists working with parents, (b) roles occupational therapists assume when working with parents, and (c) issues that arise in the working relationship with parents. Data were collected from 257 registered occupational therapists currently working with preschool children with cerebral palsy. The instrument used to collect the data was developed by the authors and other experienced clinicians. Results suggest that occupational therapists are more likely to concentrate on therapeutic objectives and techniques than deal with parental feelings Data are presented and summarized with implications for occupational therapy clinical practice.

The Effects of a Compensatory Intervention on Processing Deficits of Adults with Acquired Brain Injuries.

Deficits in visual processing are common for individuals who have acquired brain injuries (ABI). Using an experimental, matched-groups design, the researchers examined the efficacy of a cognitive rehabilitation treatment focused on instruction in the use of compensatory strategies for deficits in processing of visual information. Participating in the study were 30 adults who were 2 to 12 months post-ABI. Repeated analysis of variance measures demonstrated significant improvements in both the experimental group and the control group on both weekly and pre-test/post-test measures. Auxiliary analyses, however, revealed the use of compensatory strategies by 80% of both the experimental group and the control group, which had received a remedial intervention. Further investigation indicated that the use of compensatory strategies by both groups resulted in improved scores.

Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

OBJECTIVE To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. DESIGN Randomized, repeated-measures, mixed analysis of variance. SETTING Outpatient clinic. PARTICIPANTS Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). INTERVENTIONS Four-week arm training protocol on a robotic device (12 sessions). MAIN OUTCOME MEASURES Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up. RESULTS There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). CONCLUSIONS There were no differences in retention of motor skills between EF and IF participants 4 weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

Inter-Rater Reliability and Concurrent Validity of the Preschool Play Scale with Preschool Children with Autism Spectrum Disorders

This study examined whether the Revised Knox Preschool Play Scale (PPS-R) was reliable and valid for use in assessing play behavior of preschoolers with autism spectrum disorder (ASD). Inter-rater reliability of the PPS-R was investigated. Comparing scores on the Vineland Adaptive Behavior Scales (VABS) on 61 children determined concurrent validity of the PPS-R. Intraclass Correlation and Spearmans Rank Order Correlation coefficients revealed the PPS-R had high inter-rater reliability (r = .94) and correlated significantly (r = .52, p< .01) with the total score of the VABS, respectively. Results support the PPS-R is a reliable and valid measurement of play behavior for preschoolers with ASD.

A Protocol for Improving Loneliness in People with Multiple Sclerosis

ABSTRACT Loneliness is a subjective and unpleasant emotional state that occurs when people feel social networks or social relationships are deficient in some way. People with multiple sclerosis are often lonely and frequently withdraw from participating in meaningful social activities. Common symptoms, such as cognitive changes, decreased physical functioning, fatigue, incontinence, visual changes, or depression, may contribute to decreased social participation, which can lead to loneliness. This article presents an intervention protocol for improving loneliness in people with multiple sclerosis. This protocol is based on Bandura’s Social Learning Theory, which focuses on improving self-efficacy to reduce loneliness in people with multiple sclerosis.