Kerstin Tham

Sustained attention training for unilateral neglect: Theoretical and rehabilitation implications

Many studies have shown a co-variation of unilateral neglect with nonlateralised attentional functions. Recently, Posner has argued that there are two separate neural systems that influence the posterior attentional system which is presumed to be impaired in unilateral neglect, namely, the posterior system itself (located partly in the inferior parietal lobules) as well as a secondary modulatory sustained attention or vigilance system. This latter system is linked to the nor-epinephrine system, which is known to be more strongly represented in the right compared to the left hemisphere of the brain. If this hypothesis is true, then unilateral neglect should be improved by increasing activation of the sustained attention system. Eight patients suffering from chronic left unilateral neglect were trained to sustain their attention by a self-alerting procedure partially derived from Meichenbaums self-instructional methods. Using a multiple-baseline-by-function design, as well as multiple-baseline-by-subject designs, statistically significant improvements in unilateral neglect as well in sustained attention were found following onset of sustained attention training, without corresponding improvements in control measures. Theoretical implications for the attentional underpinnings of unilateral neglect are discussed, as well as the rehabilitation implications of this training procedure.

OCCUPATIONAL GAPS IN EVERYDAY LIFE 1 /4 YEARS AFTER ACQUIRED BRAIN INJURY

OBJECTIVE To explore adaptation, by examining the occupational gaps occurring between what individuals want to do and what they actually do in terms of their everyday activities before and after brain injury. In addition, the relationships between occupational gaps and impairment/activity limitations and the time lapse since the brain injury were explored. DESIGN A cross-sectional study. SUBJECTS A total of 187 persons, affected by traumatic brain injury or subarachnoid haemorrhage 1-4 years previously. METHODS A postal questionnaire encompassing questions concerning gaps in the performance of activities in everyday life before and after the brain injury and perceived impairment/activity limitations. RESULTS The numbers of occupational gaps increased after the injury, with the number of gaps having increased from 46% to 71%. The number of occupational gaps was significantly related to executive impairment/activity limitations, and motor impairment/activity limitations and other somatic impairments, such as headache, also had an impact. The time lapse since the brain injury had no significant effect on the number of occupational gaps. CONCLUSION The results suggests that there is a need for adaptation in everyday activities, even several years after a brain injury, which indicates that follow-up and access to individualized rehabilitation interventions in the long-term are required.

Sustained attention and awareness of disability in chronic neglect

The possible causative role of defective sustained attention and awareness of disability on the persistence of neglect was explored. The study included stroke patients who had had moderate or severe neglect 1-5 years before the start of the present examination. Questionnaire responses showed that the patients were aware of their disability. Impaired sustained attention was associated with poor performance in two out of three tests most sensitive in detecting neglect. This, together with indications of compensation on neglect tests, is interpreted as providing support for the hypothesis that chronic neglect is related to an impaired sustained attention.

Rehabilitation at home after stroke: a descriptive study of an individualized intervention

Objective: To describe the content of a programme involving early hospital discharge and continued rehabilitation at home after stroke. Design: Quantitative and qualitative descriptive study of an intervention within the context of a randomized controlled trial. Setting: Huddinge University Hospital, Stockholm, Sweden. Subjects: Forty-one patients, moderately impaired after stroke, rehabilitated by a team of six occupational, physical, and speech and language therapists. Results: The average duration of the programme was 14 weeks, the mean number of home visits 12, and the median total time consumption 23 hours and 20 minutes, of which face-to-face contact with the patient constituted 54%. The rehabilitation process was pursued by the patient and the therapist in partnership. Supported by the team the therapists incorporated a wider domain of activities than usual and left a considerable amount of the training to self-directed activities. The most common foci of the visits were speech and communication, ADL activities and ambulation. When planning the intervention the therapists paid attention to discrepancies between the desires and abilities of the patient on the one hand and environmental demands on the other – discrepancies detected through observation of the patient in the home environment. Conclusions: The home environment offers therapists working in a team opportunities to adopt a behaviour that enables patients with moderate neurological impairments after stroke to resume responsibility and influence over their rehabilitation process, resulting in an individualized rehabilitation programme that varies in duration, content and frequency of home visits.

P-drive: assessment of driving performance after stroke

OBJECTIVE To investigate aspects of validity and stability of Performance Analysis of Driving Ability (P-Drive), for people with stroke when used in a driving simulator. DESIGN A cross-sectional observational study. SUBJECTS The study included a consecutive series of 101 participants with stroke referred for evaluation or selected from a stroke registry. METHODS P-Drive was used to observe driving performance in order to assess driving ability. P-Drive comprises 20 items assessing the quality of the participants driving performance. Aspects of validity and reliability in P-Drive were evaluated using Rasch statistics. RESULTS The items (95%) and participants (97%) demonstrated acceptable goodness-of-fit and met statistical expectations according to the Rasch model. The results support internal scale validity and person response validity. P-Drive could separate the participants with different driving abilities and the standard errors were within reasonable criteria for drivers with a moderate-to-low ability to drive. CONCLUSION The findings from this study indicated that P-Drive is an assessment tool with properties of internal scale validity, person response validity, and which also contains aspects of reliability in relation to precision of the estimates and separation. P-Drive seems to be a valid and stable assessment tool for assessing the driving ability in a simulator of people with stroke.

Using electronic aids to daily living after acquired brain injury: A study of the learning process and the usability

Purpose. The purpose was to study the ability of persons with memory impairments after acquired brain injury to learn how to and use electronic aids to daily living (EADL) and to describe changes in function and quality of life. Method. Eight participants stayed in two apartments equipped with a set of basic and advanced EADL for either 4 or 6 months during an intervention time of 2 years. The teaching and learning method was influenced by certain principles of errorless learning. Ability to learn to use EADL was measured by structured observations. Function and quality of life were assessed with self-rating questionnaires. Results. Results indicate that the participants learned to use EADL in their everyday activities. They perceived that EADL were very useful and easy to learn. Occupational performance and satisfaction with occupational performance and quality of life was improved. Conclusion. The results indicate that EADL may play an important role in facilitating everyday activities and improve satisfaction with occupational performance and quality of life for people with memory impairments. The study indicates the importance of adjusting technology to the users needs and calls for more consideration for human – technology interaction factors.

Couples' happiness and its relationship to functioning in everyday life after brain injury

The objective of this survey was to identify couples’ joint perception of their satisfaction with life as a whole when one of the persons in the couple had acquired brain injury between one and five years earlier. The focus was on the influence that functioning and disability in everyday life have on the couples joint life satisfaction after brain injury. The sample consisted of 55 couples, and the mean age of the brain-injured persons was 51 years. Both persons in the couple answered a mailed questionnaire encompassing questions concerning perceived impairments, activity limitations, participation restrictions, and life satisfaction. The results showed that in 16 of the 55 couples both partners were satisfied with life as a whole. The joint experience of life satisfaction was significantly related to the couples functioning in everyday life, and specifically to perceived participation in leisure time and in their social life, and in their ability to wash clothes. Important implications from this study, showing that only one-third of the couples were satisfied, are that the partners should be included to a greater extent in the rehabilitation process and the couples perspective of what they find difficult to deal with should serve as a guide during rehabilitation.

Development of the Assessment of Awareness of Disability

It is common for clients with stroke to lack awareness of their disabilities, which is an obstacle in the rehabilitation process. The aim of this article is to describe how Rasch measurement method ...

Interaction with the Physical Environment in Everyday Occupation after Stroke: A Phenomenological Study of Persons with Visuospatial Agnosia

This study examines how persons with visuospatial agnosia following stroke experience their interaction with the physical environment in everyday occupations. Eight clients with cerebrovascular lesions agreed to participate. These participants were interviewed twice and the data were collected and analysed using the empirical phenomenological psychological (EPP) method. The findings describe three main themes comprising six main characteristics of how the physical world was experienced in a new, unfamiliar, and confusing way that interfered with the participants’ occupational performance and also with their experiences of being an individual “self-person”. Furthermore, the study highlights their constant strife for mastery over the problematic physical world, a world that did not seem to provide them with support in their everyday occupations. These findings contribute to the growing body of knowledge within occupational therapy concerning the occupational consequences of cognitive-perceptual impairments from the clients perspective.

Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke: an explorative observational study.

BackgroundPeople who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke.MethodsThe participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables “unfulfilled needs for rehabilitation” and “dissatisfaction with care” were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses.ResultsUnfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08).ConclusionsThirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients’ needs and aid peoples’ reorientation; this would apply particularly to those with poor coping capacity.