Introduction:The clinical practice patterns and use of research evidence by Australian occupational therapists working with clients experiencing neurocognitive impairments has not been surveyed for nearly 10 years. This survey aimed to evaluate the current status of occupational therapy practice and evidence use and provide recommendations for ongoing evidence translation. Methods: An online survey of occupational therapists working in Australia was conducted over four months targeting registered clinicians working with adults experiencing neurocognitive impairments. Results: 191 occupational therapists from a wide range of clinical practice areas, with a significant level of experience completed the survey. Functional retraining (n = 180, 94%), compensatory training (n = 173, 91%) and task/environmental modifications (n = 161, 84%) were the most commonly reported intervention techniques, while more targeted interventions such as context-sensitive training (n = 54, 28%), positive behaviour supports (n = 42, 22%) and metacognitive strategy training (n = 37, 19%) were used less frequently. Half the respondents were aware of current research evidence and suggested a wide range of strategies supporting evidence translation. Traditional barriers of limited time, access and skills to interpret research were also reported. Conclusion: Consistent with earlier surveys most occupational therapists continue to use a functional/compensatory approach to cognitive rehabilitation, with an increasing number of therapists using specialist cognitive interventions. The current challenge for occupational therapists is embedding specialist techniques into occupation-based intervention. Knowledge translation and implementation strategies will be a critical component to achieving this. K E Y W O R D S acquired brain injury , evidence based practice, knowledge translation , metacognitive strategy training, occupational therapy | 75 NOTT eT al.
Introduction: Few ecologically valid assessment tools are available for occupational therapists to evaluate the cognitive demands and performance of women with breast cancer in the workplace. This study aims to identify difficulties in work-related cognitive strategy use experienced by women with breast cancer using the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis. Method: Deductive content analysis was used to code secondary data from 10 interview transcripts involving women who had breast cancer and experienced difficulties in everyday cognitive functioning after treatment. Thirty-four PRPP cognitive strategy items were used as predetermined codes in a secondary analysis to identify and quantify specific cognitive difficulties described by the women. Results: The 10 women experienced problems with work tasks that required the cognitive strategies related to the 'programming', 'continuing', and 'attending' processing categories of the PRPP system. In addition, the women demonstrated strengths in their capacity to evaluate their own thinking and performance. Conclusion: This pilot study indicated the need for further research to determine how cognitive impairments which may occur after breast cancer treatment impact on occupational performance in a complex work environment. The PRPP System of Task Analysis was identified as a potentially useful measurement and interview tool for this purpose.
When considering the impact of contextual factors on paid employment for people with a dual diagnosis of spinal cord injury/traumatic brain injury, personal factors may be of greater influence than environmental factors. Study participants experienced few physical or attitudinal barriers and reported highly supportive interpersonal relationships.
Background and aim: The focus of upper limb assessment for people with neurological damage has expanded beyond impairment factors. Assessments that evaluate the impact of impairment factors within tasks are needed to ensure that interventions address task performance. The Comparative Analysis of Performance-Motor (CAP-M) identifies upper limb impairments during performance of a client-chosen occupational task and uses this information to guide goal formulation. This study investigated the clinical utility of the CAP-M with children with cerebral palsy. Method: Ten occupational therapists each administered the CAP-M with one child with cerebral palsy. The participants were involved in a focus group or focused discussion. Constant comparative analysis was used to guide data collection and identify key themes. Findings and conclusion: The participants reported that the tool was a useful addition to the current upper limb assessments available for children with spastic cerebral palsy and some voluntary movement. Useful features of the tool were its focus on meaningful tasks, its effectiveness as an observational and educational tool and its usefulness in directing intervention selection. The findings support the development of upper limb assessment tools that span a range of ages and diagnoses and link impairment level factors with task performance.
This study explores how spirituality is integrated into practice across the different Australian health professions. Utilising the Joanna Briggs Institute’s (JBI) protocol, six databases were searched, and sixty-seven articles were finally included. To present the findings, a qualitative synthesis was used. ‘Meaning’ and ‘purpose in life’ were found to be key to many spirituality definitions. The most frequently reported approach for Australian health professionals (HPs) in asking about client spirituality was using one or two questions within a comprehensive assessment. Major facilitators included a holistic care approach and prior training, whereas a key barrier was a lack of time.
Background: This study examined the efficacy of a home-based Constraint Induced Movement Therapy (CI Therapy) protocol with eight poststroke survivors. Method: Eight ABA, single case experiments were conducted in the homes of poststroke survivors. The intervention comprised restraint of the intact upper limb in a mitt for 21 days combined with a home-based and self-directed daily activity regime. Motor changes were measured using The Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL). Results: Grouped results showed statistically and clinically significant differences on the WMFT (WMFT [timed items]): Mean 7.28 seconds, SEM 1.41, 95% CI 4.40-10.18, p = 0.000; WMFT (Functional Ability): z =-4.63, p = 0.000). Seven out of the eight participants exceeded the minimal detectable change on both subscales of the MAL. Conclusion: This study offers positive preliminary data regarding the feasibility of a home-based CI Therapy protocol. This requires further study through an appropriately powered control trial.
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