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Edited by
Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester,Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich,Stephen M. Pereira, Keats House, London
Being able to do activities is an inherent human need and essential to health and well-being. This chapter relates this need to the altered experience of activity participation for people who are patients within a psychiatric intensive care unit (PICU). It explains the negative impact of impaired functioning, occupational deprivation and boredom and the converse positive effect of adequate meaningful activity provision for patients, staff and the service as a whole. It discusses how engaging patients in activity can prevent, reduce and help to manage violence and aggression. This is balanced by a discussion of how enabling positive engagement through use of activity requires careful assessment, which includes considering the environment, different aspects of functioning such as sensory processing and the risks associated with the activities described herein. The chapter provides information on a wide range of activities for individual and group-based programmes, including enabling activity participation in seclusion and using sensory interventions.
Assistive technology (AT) is any artefact that enables participation in activities usually limited by disability. Frequently, AT suffers from poor design engagement and utilisation. Moreover, up to 30% of all AT is abandoned within a year, negatively impacting users. This presents an ongoing challenge for occupational therapists (OTs) who work with assistive technologies. A literature review was conducted using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol to understand this issue and its implications for the design community. This study explores current themes of AT abandonment and the role of OT within the lens of design thinking. Studies, including design intervention in AT, were subsequently highlighted. This led to comparing this literature with more traditional health literature, exploring the potential enablers and barriers for design in engaging with AT. This evidenced the benefits of collaboration between design and OT disciplines to improve the product and reduce abandonment issues.
This chapter centres the encounter between patient and psychiatrist, and between mandate Palestine and new methods of psychiatric treatment being developed around the world in the 1930s and 1940s. In particular, it focuses on three distinct methods of treatment: patient work or occupational therapy; insulin- and cardiazol-shock therapies; and electro-convulsive therapy. All in different ways sought to work (on) the body to cure the mind, and were introduced into private and government mental institutions in mandate Palestine in the decade before 1948. Though these techniques tantalised with the promise of transcending context through their universal applicability, this chapter highlights instead how these psychiatric techniques travelled to and were deployed within Palestine in a highly uneven way, and attempts to piece together some sense of how patients and their families responded to and understood these treatments as well.
Cette étude a sondé 46 médecins de famille québécois quant à leurs pratiques pour l’évaluation et le dépistage des conducteurs à risque afin 1) de mieux comprendre leur niveau de compétence perçu; 2) de recenser les difficultés rencontrées dans le processus de prise de décision et 3) de documenter leurs besoins et attitudes quant à une collaboration plus étroite avec les ergothérapeutes. Les participants (femmes : 84,8 %; moyenne d’expérience : 15,7 (±12,1) ans) ont répondu à un sondage en ligne de 30 questions. Les résultats de cette étude démontrent que malgré un certain confort à effectuer l’évaluation et le dépistage des conducteurs à risque, les médecins ne se considèrent pas comme les professionnels les mieux qualifiés pour ce faire. Ils reconnaissent également le rôle que jouent les ergothérapeutes dans le dépistage de cette clientèle et l’intervention auprès d’elle. Ils voient ainsi la pertinence d’avoir accès aux services de ces professionnels en soins de première ligne.
Comment soutenir le déploiement de connaissances coconstruites par des personnes cliniciennes, gestionnaires ou chercheures? Ce thème est abordé à partir de l’étude de l’application de l’Algo, un algorithme clinique décisionnel conçu pour la sélection des aides techniques visant à faciliter l’hygiène corporelle des personnes aînées vivant à domicile. L’objectif de cette note sur les politiques et les pratiques est de présenter les orientations de facilitation dégagées à la suite d’un devis mixte multiphases (2015–2019) mis en œuvre dans les services de soutien à domicile au Québec (Canada). Les orientations de facilitation centrée sur la tâche et holistique sont présentées en fonction des stades d’utilisation de l’Algo, afin de soutenir les personnes cliniciennes, gestionnaires et chercheures dans la poursuite de son application auprès des personnes aînées. De plus, cette note illustre l’apport des devis mixtes à la conduite et à la compréhension de l’application des connaissances coconstruites.
Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists’ role in caring for infants with critical CHD in intensive or acute care hospital units.
Purpose:
This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed.
Conclusions:
Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant’s overall development.
To examine and describe the current evidence about occupational therapy services in primary care.
Background:
Interprofessional primary care teams have been introduced to support the changing demographics and provide more comprehensive and coordinated care. Occupational therapists have the opportunity to play an important role in this expanding area of practice. To do so, occupational therapists must develop roles built on evidence and a clear understanding of the care delivery context.
Methods:
A scoping review was conducted based on the scientific and grey literature. Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. The Canadian Model of Occupational Performance and Engagement was used to chart the data.
Findings:
129 articles were identified, with 62 non-research and 67 research-focussed articles. A total of 268 assessments and 868 interventions were identified. The top interventions offered by occupational therapists were referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), chronic disease management (n = 34 articles)/self-management education (n = 28 articles), health promotion (n = 30 articles) and falls prevention (n = 27 articles). The predominant focus in the literature is on adult and older adult populations.
Occupational therapy (OT) offers evidence-based methods to address daily functioning improvement and better health promotion. However, many adults who are dealing with deficient daily functioning due to unrecognized Attention Deficit Hyperactivity disorder (ADHD) do not benefit from these developed methods. Thus, they are at risk of experiencing adjustment barriers and poor mental health.
Objectives
The aim of this project is to develop a dissemination strategy in order to reach-out for this unrecognized ADHD population and grasp their attention in an early stage of life. The study following this project is measuring the possibility of this action to reach out to the individuals and make a small change in their daily functional capabilities.
Methods
The Laboratory for the Study of Complex Human Activity and Participation (CHAP) is a lab sited in the occupational therapy department at the University of Haifa. Its research address ADHD as part of further neuro-developmental challenges in the life span. The lab started a dissemination program including 4 OT researchers, and a group of former researchers for materials feedback.
Results
In the presentation we will share the dissemination strategy and it implementation during 6 months. Moreover, we will present a theoretically map relevant virtual pathways that adults with unrecognized ADHD may cross since childhood.
Conclusions
This preventative program towards health promotion aims to help people achieve meaningful milestones in life and live more fully. Moreover, this strategy may serve as a prototype for similar approaches in other outreach processes.
According to the Medical Subject Headings, the vocabulary used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’. Studies on procrastination are increasing, especially among university students, gaining prominence in academic literature. However, studies on the procrastination phenomenon have been mainly quantitative, correlating such experiences with clinical and behavioral manifestations. Specific research with occupational therapy students is lacking in the literature.
Objectives
To interpret symbolic meanings related to life experiences of the procrastination phenomenon of school tasks as reported by occupational therapy undergraduate students, self-referred as procrastinators.
Methods
Clinical-qualitative design. Data collected through semi-directed interviews with open-ended questions in-depth. Clinical-Qualitative Content Analysis generated categories discussed in the light of the psychodynamic theoretical framework. This study was carried out in a private Brazilian university. The sample was closed by the information saturation criterion.
Results
Seven students were interviewed. Procrastination comes associated with anxiety as productivity, but not reported as an “executive drive”, that would imprison the individual in a vicious cycle. There are defense mechanisms referred to as self-preservation for not assume responsibilities for tasks. Ineffective strategies seem to be experienced by the students to avoid procrastination, but without resolving possible psychodynamic conflicts related to the task.
Conclusions
Students’ procrastination ambivalently affects their daily lives, although they can report the phenomenon as negative. It is suggested further qualitative studies that explore specifically meanings of procrastinating personal activities, in general, considering these individuals will work precisely in a therapeutic approach in the field of occupations of the people.
To clarify the characteristic of impaired and unimpaired Instrumental Activities of daily living (IADL) processes with the severity of cognitive impairment in community-dwelling older adults with Alzheimer’s disease (AD) using the Process Analysis of Daily Activity for Dementia (PADA-D).
Design:
Cross-sectional study.
Setting:
13 medical and care centers in Japan.
Participants:
115 community-dwelling older adults with AD.
Methods:
The severity of cognitive impairment was classified by Mini-Mental State Examination (20 ≥ mild group, 20 < moderate group ≥ 10, 10 < severe group), and IADL scores and eight IADL items in PADA-D were compared among three groups after adjusting for covariates. Rate of five feasible processes included in each IADL of PADA-D was compared.
Results:
IADL score showed a decrease in independence with the severity of AD except for Use modes of transportation and Managing finances, which was especially pronounced in Shopping (F = 25.58), Ability to use the telephone (F = 16.75), and Managing medication (F = 13.1). However, when the PADA-D was examined by process, some processes that were impaired and unimpaired with the severity of cognitive impairment were clear. For example, Plan a meal was impaired (ES = 0.29) with the severity, but Prepare the food was not in Cooking performance.
Conclusions:
We suggested that detailed process analysis in IADLs can clarify the characteristic of processes that are impaired and unimpaired with the severity of cognitive impairment in older adults with AD living in the community. Our findings may be useful for rehabilitation and care in IADL to continue living at home.
This paper provides a brief overview of the history of occupational therapy in psychiatry in Ireland and explores why the contribution of an early Irish psychiatrist and proponent of occupational therapy, Dr Eamon O’Sullivan (1897–1966), was not fully recognised in the decades after his retirement in 1962.
Methods:
A review of selected key reports, papers and publications related to the history of occupational therapy was undertaken.
Results:
Eamon O’Sullivan was appointed Resident Medical Superintendent at Killarney Mental Hospital Co. Kerry in 1933 and developed an occupational therapy department at the hospital from the 1930s until his retirement in 1962. He wrote one of the first textbooks of occupational therapy published in 1955. His occupational therapy philosophy reflects the early decades after the formalisation of the profession in 1917 when beliefs about the curative properties of occupation flourished and professional education programmes were scarce. By the time O’Sullivan’s textbook was published it received a lukewarm reception within occupational therapy as it did not reflect 1950s practice and professional philosophy. The professionalisation of occupational therapy in Ireland in the 1960s was also a factor in the lack of acknowledgement of O’Sullivan’s contribution to the profession.
Conclusion:
Practice and professional philosophy change and the paper concludes by considering O’Sullivan’s work in light of contemporary occupational therapy which once again places occupation at its centre and emphasises the importance of balance, health and wellbeing.
This chapter describes exemplary curricula in the sciences and engineering that give expression to many of the ideals of decolonization. Despite claims about the value neutrality and universality of the sciences, broadly defined, these exemplars demonstrate how to decolonize curricula in engineering, computer science, occupational therapy, organic chemistry, and archaeology. These curriculum innovators are conscious of the social dimensions of the sciences and what this means for improving the human condition.
Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients.
Objectives:
To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service.
Method:
A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed.
Results:
Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was −3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service.
Conclusion:
Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI.
Challenging transitions, increased stress and mental ill health can affect students’ academic performance and their capacity to remain in higher education. Prevention and early treatment of mental health problems in college students is therefore a key public health priority, nationally and internationally. Developing a range of evidence-based interventions targeting the mental health of students is critical. We examined the feasibility and acceptability of a new universal time use and well-being intervention, the ‘Everyday Matters: Healthy Habits for University Life’ digital badge (EMDB), a co-curricular micro-credential for first-year college students.
Methods:
This study used a single-arm, pre–post design for first-year undergraduate students. The EMDB comprised eight 1-hour lunchtime sessions on brain development and time-use habits across the 24 hours of the day including sleep, self-care, leisure, study and work. Validated measures of occupational competence and value, mental well-being, sleep health, mindset, self-compassion and gratitude were completed, along with an evaluation questionnaire.
Results:
Eight first-year undergraduate students completed the demographic questionnaire and pre- and post- measures, with one additional student completing only the evaluation questionnaire. There was significantly improved levels of well-being, self-compassion and growth mindset following the intervention. Many of the challenges reported by participants related to occupational issues such as managing finances and having a satisfying routine. Participants appreciated the practical relevance and scientific underpinnings of the programme content. The sense of belonging within the group and having insightful conversations with other group members were particularly valued by participants.
Conclusions:
This study offers preliminary evidence that an occupational therapy based universal time-use and well-being intervention was feasible to deliver and acceptable to first-year undergraduate students. The results of this study and the participant acceptability support further development and evaluation of the EMDB intervention.
Work-related musculoskeletal disorders in ENT surgeons are common and detrimental, yet few are aware of preventative measures. We evaluate the evidence for interventions to prevent work-related musculoskeletal disorders in ENT surgeons.
Method
A systematic search of databases up to 8 June 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and predetermined inclusion criteria.
Results
Seven prospective cohort studies and 2 case series were identified (51 participants). Interventions included novel equipment (n = 3), patient positioning (n = 2), clinician positioning (n = 3) and operative technique (n = 1). Five studies reported Rapid Upper Limb Assessment scores as outcome measures of strain. Strain decreased when adopting a favourable operating posture, using a supportive chair and keeping patients supine for clinic procedures.
Conclusion
A small number of low-quality studies were identified. Modifiable risk factors exist, and ergonomic education may help prevent work-related musculoskeletal disorders. Further studies with longer term follow up are required.
To validate an informant-based tool – the extended version of the Cognitive Scale of Basic and Instrumental Activities of Daily Living (BADL and IADL) or Ext. Cog-ADL Scale – in a larger sample and with a broader range of cognitive-functional items related to activities of daily living (ADL).
Method:
The Ext. Cog-ADL Scale was administered to family informants of 42 patients with dementia, 43 patients with multidomain mild cognitive impairment (mdMCI), and 23 healthy control participants. We analyzed the convergent and concurrent validity and external validity of this scale.
Results:
The Ext. Cog-ADL Scale demonstrated good psychometric properties. Episodic and working memory tests were the main predictors of most cognitive-functional items of the scale. While patients with dementia obtained lower scores in most error categories of the scale, affecting both BADL and IADL, mdMCI patients showed a more specific pattern of difficulties. Apart from the typical alterations in IADL, mdMCI patients also showed difficulties in several error categories related to BADL (i.e., error detection, problem solving, task self-initiation, distraction inhibition, and restore).
Conclusions:
The Ext. Cog-ADL Scale seems to be an adequate tool to capture the specific pattern of cognitive alterations related to IADL and BADL that differentiates dementia from mdMCI and healthy aging; it shows that mdMCI can involve specific cognitive difficulties that affect even BADL.
Wearable cameras have been shown to improve memory in people with hippocampal amnesia and Alzheimer's disease. It is not known whether this benefit extends to people with amnesia of complex or uncertain origin.
Method:
This case study examined the effect of wearable camera use on memory and occupational performance in a patient with memory loss and complex mental health problems following a severe neurological incident. With the help of his occupational therapist (OT), Mr A used a wearable camera to record a series of eight personally significant events over a 6-week period. During visits from his OT, Mr A was asked to report what he could remember about the events, both before (baseline) and during the review of time-lapsed photographs captured automatically by the camera.
Results:
The results showed striking improvements in recall while reviewing the photographs, relative to baseline recall, but the additional details recalled during review did not appear to be maintained at later tests, after several days. Across the study period, there were moderate increases in occupational performance, measured using the Canadian Occupational Performance Measure. However, after the study period ended, Mr A ceased to use the wearable camera due to technological difficulty.
Conclusion:
There was a clear benefit of wearable camera use, but the real-world impact of the technology was limited by the complexity of the system. The results of the study are discussed alongside novel clinical insights and suggestions for developing wearable camera support systems that can be used independently by people with memory problems.
Most patients with suspected stroke should be transported without delay to a hospital, which has access to the required diagnostic tests and appropriate hyperacute treatments 24 h/day and 7 days/week. Once admitted, patients should be managed in a stroke unit rather than a general medical ward. There appears to be no systematic increase in length of hospital stay associated with organized (stroke unit) care. The recent development of hyperacute stroke units is not based on evaluation within RCTs but appears to improve processes of care in the acute phase. Processes of care on a stroke unit should mirror those found to be effective in RCTs. Stroke care should be specialized, organized, and multidisciplinary (i.e. provided by medical, nursing, physiotherapy, occupational therapy, speech therapy, and social work staff who are interested and trained in stroke care). The other beneficial components of organized stroke care are likely to be many, but it remains uncertain which are the most effective. Early discharge from the stroke unit with support from a domiciliary rehabilitation team (coordinated by the stroke unit) promises to reduce hospital length of stay and improve rehabilitation in the home and patient outcome.
The Tailored Activity Program (TAP) is an evidence-based occupational therapist-led intervention for people living with dementia and their care partners at home, developed in the USA. This study sought to understand its acceptability to people living with dementia, their care partners, and health professionals, and factors that might influence willingness to participate prior to its implementation in Australia.
Methods:
This study used qualitative descriptive methods. Semi-structured interviews were conducted with people living with dementia in the community (n = 4), their care partners (n = 13), and health professionals (n = 12). People living with dementia were asked about health professionals coming to their home to help them engage in activities they enjoy, whereas care partners’ and health professionals’ perspectives of TAP were sought, after it was described to them. Interviews were conducted face-to-face or via telephone. All interviews were recorded and transcribed. Framework analysis was used to identify key themes.
Results:
Analysis identified four key themes labelled: (i) TAP sounds like a good idea; (ii) the importance of enjoyable activities; (iii) benefits for care partners; and (iv) weighing things up. Findings suggest the broad, conditional acceptability of TAP from care partners and health professionals, who also recognised challenges to its use. People living with dementia expressed willingness to receive help to continue engaging in enjoyable activities, if offered.
Discussion:
While TAP appeared generally acceptable, a number of barriers were identified that must be considered prior to, and during its implementation. This study may inform implementation of non-pharmacological interventions more broadly.
Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees’ and staff’s perspective concerning the real ward atmosphere and that the staff’s perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff’s estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee’s perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time.