Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these five recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes, (2) utilizing transition specialists, (3) implementing a patient-centered discharge checklist, (4) utilizing standardized outcome measures, and (5) establishing partnerships with community wellness programs. Due to changes in healthcare policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during post-stroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand-off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (early supported discharge, planned pre-discharge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.

Although cognitive assessments are widely used in home health care, occupational therapy practitioners are selecting nonstandardized assessments most frequently to assess cognition.

Themes described quality of life as a dynamic experience that changed as activities of value were lost or gained and as participants experienced changes in their perspectives, beliefs, values, and behaviors. The discussion examines these themes through the lens of the Model of Human Occupation and the Shifting Perspectives Model of Chronic Illness. Clinical implications of the results are also discussed.

OBJECTIVE. Our objective was to perform initial psychometric analysis of the Multiple Errands Test Home Version (MET–Home), which was designed to assess the influence of poststroke executive dysfunction on in-home task performance. METHOD. We examined the reliability and validity of the MET–Home in adults with stroke (n = 23) and individually matched control participants (n = 23). All participants completed a series of assessments during a single in-home visit. RESULTS. Notable differences in MET-Home subscores were discovered between participants with stroke and control participants. Participants with stroke omitted more tasks, broke more rules, passed by tasks more often, and were less efficient than matched control participants. The MET–Home demonstrated evidence of adequate internal consistency, excellent interrater reliability, and significant moderate associations with several tests. CONCLUSION. This preliminary study suggests that the MET–Home differentiates between adults with stroke and matched control participants. The MET–Home provides evidence of initial reliability and validity among adults with stroke.

Principles of experience-dependent plasticity, motor learning theory, and the theory of Occupational Adaptation coalesce into a translational model for practice in neurorehabilitation. The objective of this study was to explore the effectiveness of a Task Oriented Training and Evaluation at Home (TOTE Home) program completed by people with subacute stroke, and whether effects persisted 1 month after this training. A single-subject design included a maximum of 30, 1hour sessions of training conducted in participants' homes. Repeated target measures of accelerometry and level of confidence were used to assess movement and confidence in weaker arm use through baseline, intervention, and follow-up phases of TOTE Home. Four participants completed TOTE Home and each demonstrated improvement in movement and confidence in function. The degree of improvement varied between participants, but a detectable change was evident in outcome measures. TOTE Home, using client-centered, salient tasks not only improved motor function but also facilitated an adaptive response demonstrated in continued improvement beyond the intervention.