Archives of Physical Medicine and Rehabilitation, Oct 1, 2021
Research Objectives To develop and test the concurrent validity and acceptability of an electroni... more Research Objectives To develop and test the concurrent validity and acceptability of an electronic form of the Activity Card Sort. Design Cross-sectional, single group design. Setting University laboratory. Participants A convenience sample of community-dwelling adults (n=20) was recruited with the following inclusion criteria: >45 years old and able to speak and read English fluently. Interventions Not applicable. Main Outcome Measures The Activity Card Sort (ACS) is a valid and reliable tool commonly used to measure daily life participation (1,2,3). The ACS consists of 89 cards representing various daily activities. Cards are sorted into the following categories: (1) I have never done, (2) I have not done as an adult, (3), I do less, (4) I have given up, or (5) I continue to do. The ACS assesses activity participation and changes in participation over time in four categories: social, low-demand leisure, high-demand leisure, and instrumental activities of daily living. An electronic form of the ACS (ACS3) was developed to improve ease of administration (i.e. speed, fewer materials needed) and electronic documentation and to allow for remote administration (4). The ACS3 was designed with three representative photographs per activity with a diverse representation of individuals. Order of assessment administration was counter-balanced across participants. The ACS3 may be administered through any device that supports Mac or Windows systems. The ACS3 was delivered via an iPAD for the current study. A 7-item survey with a 5-point Likert scale (0=strongly disagree, 4=strongly agree) was used to evaluate the acceptability of the ACS3. Results High correlations were demonstrated between each of the subscales of the ACS and ACS3 (rs> .84) indicating high concurrent validity. Excellent ratings (Mean=3.7) on the survey were found indicating high levels of acceptability. Conclusions Positive perceptions of acceptability and high concurrent validity suggest the ACS3 may be an acceptable tool for evaluating participation in adults. Findings align with prior research evaluating consistency between paper and electronic forms of patient-reported outcome measures. Further research may be required to determine validity of the ACS3 in clinical populations. Author(s) Disclosures None declared.
American Journal of Occupational Therapy, Jul 1, 2008
This study examined the reliability and validity of the Executive Function Performance Test (EFPT... more This study examined the reliability and validity of the Executive Function Performance Test (EFPT). The EFPT assesses executive function deficits in the performance of real-world tasks. It uses a structured cueing and scoring system to assess higher-level cognitive functions, specifically initiation, organization, sequencing safety and judgment, and task completion. Seventy-three participants with mild to moderate stroke and 22 age-and education-matched controls completed the 4 EFPT tasks (cooking, using the telephone, managing medications, and paying bills). Significant differences were found between participants with mild and moderate stroke and healthy control participants. The EFPT can help occupational therapists determine the level of support needed by people with cognitive impairments to perform complex instrumental tasks. Objective information derived from this assessment is an essential part of the process of determining whether the person can live independently and helping families understand how to support the performance of their family members at home.
Importance: Guidance is limited for training protocols that support stakeholders who are new to p... more Importance: Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software. Objective: To explore stakeholders’ experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom). Design: Ad hoc exploratory thematic analysis. Setting: Community-based telerehabilitation. Participants: Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4). Intervention: Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation. Outcomes and Measures: Semistructured interviews. Results: Stakeholders included group members (...
BackgroundCommunity participation is an important outcome of rehabilitation following traumatic b... more BackgroundCommunity participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking.ObjectiveTo examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury.DesignThis was a repeated measures study with assessments administered twice (3 months apart).SettingAssessments were administered either over the phone, virtually (Zoom), or in person at the participant's home.ParticipantsA total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited.Main Outcome MeasureThe Enfranchisement scale...
Importance: The Activity Card Sort is a valid, widely used measure of participation. There is a n... more Importance: The Activity Card Sort is a valid, widely used measure of participation. There is a need for remotely delivered measures of participation to support the growing use of telehealth. Objective: To develop and test the concurrent validity and acceptability of the electronic Activity Card Sort (ACS3). Design: Cross-sectional. Setting: Research laboratory. Participants: Community-dwelling adults. Outcomes and Measures: The Activity Card Sort (ACS) and the ACS3 were administered in randomized order. Relationships between performance on the overlapping items of the ACS and ACS3 were evaluated using Spearman’s ρ correlations. Additionally, acceptability of the ACS3 was evaluated using a survey with a 5-point Likert scale. Results: High correlations were found between each of the four domains (rs ≥ .836) and total current activities score (rs = .863) between the ACS and ACS3. Ratings on the survey indicate high levels of acceptability and usability for the ACS3. Conclusions and Re...
ABSTRACT Objective To characterize the intervention elements associated with improvements in acti... more ABSTRACT Objective To characterize the intervention elements associated with improvements in activity and participation outcomes for adults with brain injury. Data Sources PubMed and PsycINFO/Ovid. Study Selection We included RCTs that examined interventions for adults with acquired brain injury with an activity or participation outcome measure. Data Extraction We classified intervention elements and extracted effect sizes. We examined patterns of effect sizes associated with each intervention element based on time of follow-up and level of outcome (home versus community). Data Synthesis Thirty-nine articles were included. Outcomes focused on the performance of home and community activities. There was wide variation in effect sizes across all intervention elements, as well as by time and by outcome level (home versus community). Metacognitive interventions and daily life skills interventions showed the greatest promise for improving performance of home and community activities. Additionally, cognitive training interventions may play a role in improving home activity performance and social skills training interventions may play a role in community activity performance. Physical activity interventions showed the least promise for improving home and community activity performance. Conclusion This study highlights the importance of interventions that incorporate explicit strategies and task-specific training, rather than only addressing specific injury-related impairments.
ObjectiveThis study determined the sensitivity to change of the Enfranchisement scale of the Comm... more ObjectiveThis study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke.Data sourcesWe analyzed data from two studies of participants with stroke: an intervention study and an observational study.Main measuresThe Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14–70) and the Control subscale (choice and control: range: 13–64).Data analysisAssessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference.ResultsThe Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum de...
Archives of Physical Medicine and Rehabilitation, 2021
Research Objectives We explored stakeholders’ experiences using videoconferencing to participate ... more Research Objectives We explored stakeholders’ experiences using videoconferencing to participate in group-based social learning during the COVID-19 pandemic. Design Qualitative thematic analysis. Setting Community-based. Participants We interviewed 8 community-dwelling low-income adults with chronic stroke (≥ 3 months) and mild-to-moderate disability (NIH Stroke Scale ≤16) who enrolled in the ENGAGE Pilot Study (NCT04019275) during the COVID-19 pandemic. Research staff (n=4), peer facilitators (n=2), and occupational therapist facilitators (n=2) were also interviewed. Interventions ENGAGE blends social learning, guided discovery, and skills training to facilitate community and social participation. The 8-session curriculum was adapted for delivery via videoconferencing during the COVID-19 pandemic. Peer and occupational therapy facilitators led the groups. Main Outcome Measures Semi-structured interviews were conducted. Interviews were transcribed, annotated, and coded by 3 researchers. Results were member checked. Results Stakeholders reported that they valued participation in the intervention using videoconferencing and connectedness through shared experiences. Some participants felt more comfortable sharing experiences over videoconferencing than in person. The COVID-19 pandemic prompted participants and facilitators to identify creative approaches to community and social participation. All stakeholders highlighted technical and social components of using videoconferencing that should be included in training at the beginning of remotely delivered interventions. Learning occurred over the duration of the group sessions rather than during one training session. Group facilitators also described strategies for navigating technical challenges and engaging participants during online group sessions. Conclusions Group-based interventions delivered via videoconferencing may facilitate valuable social learning experiences after stroke. Videoconferencing training should address technical skills and social expectations. Future research should explore stakeholder preferences for virtual or face-to-face group interventions, virtual group processes, and optimal training strategies to facilitate technology uptake. Author(s) Disclosures This research was supported by the following: T32 Precision Lifestyle Medicine and Translational Research (PREMIER) Postdoctoral Training Program (NHLBI T32HL134634); NIH CTSA SPIRiT Award (University of Pittsburgh, UL1 TR001857; Washington University in St. Louis, UL1 TR002345).
Purpose: To investigate the effect of adding cognitive strategy training to task-specific trainin... more Purpose: To investigate the effect of adding cognitive strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. ä IMPLICATIONS FOR REHABILITATION Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of cognitive-strategies. Incorporating cognitive strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
Archives of Physical Medicine and Rehabilitation, 2019
People interested in the research are advised to contact the author for the final version of the ... more People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:
Background. Current assessments do not capture the dynamic and complex process of managing differ... more Background. Current assessments do not capture the dynamic and complex process of managing different individual and environmental factors influencing community participation post-stroke. Purpose. The purpose of this study was to examine the psychometric properties of the Community Participation Activation Scale (CPAS) in persons with stroke. Method. Rating scale structure, unidimensionality, reliability and precision, construct validity, and differential item functioning of the CPAS were examined with 93 community-dwelling people with stroke. Findings. The CPAS consists of 15 action items and 10 attitude items. Person separation reliabilities of the action and attitude domains were .75 and .72, respectively, and internal consistency reliabilities were good (>.80). The CPAS showed low to moderate correlation with community integration and enfranchisement constructs. Implications. The CPAS may be used as an assessment to better understand an individual’s level of activation and to ...
Background: Executive functions (EF) are essential for independence and engagement in complex act... more Background: Executive functions (EF) are essential for independence and engagement in complex activities. Neuropsychological and functional evaluations of stroke outcome may be insensitive to subtle EF deficits present in mild stroke (mCVA) despite low NIHSS scores and excellent outcome based on the Barthel Index (BI>95) and Modified Rankin Scale (MRS< 1). We evaluated EF deficits in 25 individuals with first mCVA (admission NIHSS < 5) and 21 matched controls on the Multiple Errands Test-Revised (MET-R). Methods: Inclusion criteria: age > 18 years, first clinical stroke, functional independence (pre-stroke BI >95 and MRS < 1) and community residence at admission and 6 month follow-up. Demographic and clinical information were obtained at acute admission to acute neurology stroke service. Stroke was confirmed by a neurologist and acute imaging reviewed to score stroke lesions and location and white matter disease. Six month follow-up included a neuropsychological te...
Archives of Physical Medicine and Rehabilitation, Oct 1, 2021
Research Objectives To develop and test the concurrent validity and acceptability of an electroni... more Research Objectives To develop and test the concurrent validity and acceptability of an electronic form of the Activity Card Sort. Design Cross-sectional, single group design. Setting University laboratory. Participants A convenience sample of community-dwelling adults (n=20) was recruited with the following inclusion criteria: >45 years old and able to speak and read English fluently. Interventions Not applicable. Main Outcome Measures The Activity Card Sort (ACS) is a valid and reliable tool commonly used to measure daily life participation (1,2,3). The ACS consists of 89 cards representing various daily activities. Cards are sorted into the following categories: (1) I have never done, (2) I have not done as an adult, (3), I do less, (4) I have given up, or (5) I continue to do. The ACS assesses activity participation and changes in participation over time in four categories: social, low-demand leisure, high-demand leisure, and instrumental activities of daily living. An electronic form of the ACS (ACS3) was developed to improve ease of administration (i.e. speed, fewer materials needed) and electronic documentation and to allow for remote administration (4). The ACS3 was designed with three representative photographs per activity with a diverse representation of individuals. Order of assessment administration was counter-balanced across participants. The ACS3 may be administered through any device that supports Mac or Windows systems. The ACS3 was delivered via an iPAD for the current study. A 7-item survey with a 5-point Likert scale (0=strongly disagree, 4=strongly agree) was used to evaluate the acceptability of the ACS3. Results High correlations were demonstrated between each of the subscales of the ACS and ACS3 (rs> .84) indicating high concurrent validity. Excellent ratings (Mean=3.7) on the survey were found indicating high levels of acceptability. Conclusions Positive perceptions of acceptability and high concurrent validity suggest the ACS3 may be an acceptable tool for evaluating participation in adults. Findings align with prior research evaluating consistency between paper and electronic forms of patient-reported outcome measures. Further research may be required to determine validity of the ACS3 in clinical populations. Author(s) Disclosures None declared.
American Journal of Occupational Therapy, Jul 1, 2008
This study examined the reliability and validity of the Executive Function Performance Test (EFPT... more This study examined the reliability and validity of the Executive Function Performance Test (EFPT). The EFPT assesses executive function deficits in the performance of real-world tasks. It uses a structured cueing and scoring system to assess higher-level cognitive functions, specifically initiation, organization, sequencing safety and judgment, and task completion. Seventy-three participants with mild to moderate stroke and 22 age-and education-matched controls completed the 4 EFPT tasks (cooking, using the telephone, managing medications, and paying bills). Significant differences were found between participants with mild and moderate stroke and healthy control participants. The EFPT can help occupational therapists determine the level of support needed by people with cognitive impairments to perform complex instrumental tasks. Objective information derived from this assessment is an essential part of the process of determining whether the person can live independently and helping families understand how to support the performance of their family members at home.
Importance: Guidance is limited for training protocols that support stakeholders who are new to p... more Importance: Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software. Objective: To explore stakeholders’ experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom). Design: Ad hoc exploratory thematic analysis. Setting: Community-based telerehabilitation. Participants: Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4). Intervention: Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation. Outcomes and Measures: Semistructured interviews. Results: Stakeholders included group members (...
BackgroundCommunity participation is an important outcome of rehabilitation following traumatic b... more BackgroundCommunity participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking.ObjectiveTo examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury.DesignThis was a repeated measures study with assessments administered twice (3 months apart).SettingAssessments were administered either over the phone, virtually (Zoom), or in person at the participant's home.ParticipantsA total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited.Main Outcome MeasureThe Enfranchisement scale...
Importance: The Activity Card Sort is a valid, widely used measure of participation. There is a n... more Importance: The Activity Card Sort is a valid, widely used measure of participation. There is a need for remotely delivered measures of participation to support the growing use of telehealth. Objective: To develop and test the concurrent validity and acceptability of the electronic Activity Card Sort (ACS3). Design: Cross-sectional. Setting: Research laboratory. Participants: Community-dwelling adults. Outcomes and Measures: The Activity Card Sort (ACS) and the ACS3 were administered in randomized order. Relationships between performance on the overlapping items of the ACS and ACS3 were evaluated using Spearman’s ρ correlations. Additionally, acceptability of the ACS3 was evaluated using a survey with a 5-point Likert scale. Results: High correlations were found between each of the four domains (rs ≥ .836) and total current activities score (rs = .863) between the ACS and ACS3. Ratings on the survey indicate high levels of acceptability and usability for the ACS3. Conclusions and Re...
ABSTRACT Objective To characterize the intervention elements associated with improvements in acti... more ABSTRACT Objective To characterize the intervention elements associated with improvements in activity and participation outcomes for adults with brain injury. Data Sources PubMed and PsycINFO/Ovid. Study Selection We included RCTs that examined interventions for adults with acquired brain injury with an activity or participation outcome measure. Data Extraction We classified intervention elements and extracted effect sizes. We examined patterns of effect sizes associated with each intervention element based on time of follow-up and level of outcome (home versus community). Data Synthesis Thirty-nine articles were included. Outcomes focused on the performance of home and community activities. There was wide variation in effect sizes across all intervention elements, as well as by time and by outcome level (home versus community). Metacognitive interventions and daily life skills interventions showed the greatest promise for improving performance of home and community activities. Additionally, cognitive training interventions may play a role in improving home activity performance and social skills training interventions may play a role in community activity performance. Physical activity interventions showed the least promise for improving home and community activity performance. Conclusion This study highlights the importance of interventions that incorporate explicit strategies and task-specific training, rather than only addressing specific injury-related impairments.
ObjectiveThis study determined the sensitivity to change of the Enfranchisement scale of the Comm... more ObjectiveThis study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke.Data sourcesWe analyzed data from two studies of participants with stroke: an intervention study and an observational study.Main measuresThe Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14–70) and the Control subscale (choice and control: range: 13–64).Data analysisAssessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference.ResultsThe Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum de...
Archives of Physical Medicine and Rehabilitation, 2021
Research Objectives We explored stakeholders’ experiences using videoconferencing to participate ... more Research Objectives We explored stakeholders’ experiences using videoconferencing to participate in group-based social learning during the COVID-19 pandemic. Design Qualitative thematic analysis. Setting Community-based. Participants We interviewed 8 community-dwelling low-income adults with chronic stroke (≥ 3 months) and mild-to-moderate disability (NIH Stroke Scale ≤16) who enrolled in the ENGAGE Pilot Study (NCT04019275) during the COVID-19 pandemic. Research staff (n=4), peer facilitators (n=2), and occupational therapist facilitators (n=2) were also interviewed. Interventions ENGAGE blends social learning, guided discovery, and skills training to facilitate community and social participation. The 8-session curriculum was adapted for delivery via videoconferencing during the COVID-19 pandemic. Peer and occupational therapy facilitators led the groups. Main Outcome Measures Semi-structured interviews were conducted. Interviews were transcribed, annotated, and coded by 3 researchers. Results were member checked. Results Stakeholders reported that they valued participation in the intervention using videoconferencing and connectedness through shared experiences. Some participants felt more comfortable sharing experiences over videoconferencing than in person. The COVID-19 pandemic prompted participants and facilitators to identify creative approaches to community and social participation. All stakeholders highlighted technical and social components of using videoconferencing that should be included in training at the beginning of remotely delivered interventions. Learning occurred over the duration of the group sessions rather than during one training session. Group facilitators also described strategies for navigating technical challenges and engaging participants during online group sessions. Conclusions Group-based interventions delivered via videoconferencing may facilitate valuable social learning experiences after stroke. Videoconferencing training should address technical skills and social expectations. Future research should explore stakeholder preferences for virtual or face-to-face group interventions, virtual group processes, and optimal training strategies to facilitate technology uptake. Author(s) Disclosures This research was supported by the following: T32 Precision Lifestyle Medicine and Translational Research (PREMIER) Postdoctoral Training Program (NHLBI T32HL134634); NIH CTSA SPIRiT Award (University of Pittsburgh, UL1 TR001857; Washington University in St. Louis, UL1 TR002345).
Purpose: To investigate the effect of adding cognitive strategy training to task-specific trainin... more Purpose: To investigate the effect of adding cognitive strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. ä IMPLICATIONS FOR REHABILITATION Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of cognitive-strategies. Incorporating cognitive strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
Archives of Physical Medicine and Rehabilitation, 2019
People interested in the research are advised to contact the author for the final version of the ... more People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:
Background. Current assessments do not capture the dynamic and complex process of managing differ... more Background. Current assessments do not capture the dynamic and complex process of managing different individual and environmental factors influencing community participation post-stroke. Purpose. The purpose of this study was to examine the psychometric properties of the Community Participation Activation Scale (CPAS) in persons with stroke. Method. Rating scale structure, unidimensionality, reliability and precision, construct validity, and differential item functioning of the CPAS were examined with 93 community-dwelling people with stroke. Findings. The CPAS consists of 15 action items and 10 attitude items. Person separation reliabilities of the action and attitude domains were .75 and .72, respectively, and internal consistency reliabilities were good (>.80). The CPAS showed low to moderate correlation with community integration and enfranchisement constructs. Implications. The CPAS may be used as an assessment to better understand an individual’s level of activation and to ...
Background: Executive functions (EF) are essential for independence and engagement in complex act... more Background: Executive functions (EF) are essential for independence and engagement in complex activities. Neuropsychological and functional evaluations of stroke outcome may be insensitive to subtle EF deficits present in mild stroke (mCVA) despite low NIHSS scores and excellent outcome based on the Barthel Index (BI>95) and Modified Rankin Scale (MRS< 1). We evaluated EF deficits in 25 individuals with first mCVA (admission NIHSS < 5) and 21 matched controls on the Multiple Errands Test-Revised (MET-R). Methods: Inclusion criteria: age > 18 years, first clinical stroke, functional independence (pre-stroke BI >95 and MRS < 1) and community residence at admission and 6 month follow-up. Demographic and clinical information were obtained at acute admission to acute neurology stroke service. Stroke was confirmed by a neurologist and acute imaging reviewed to score stroke lesions and location and white matter disease. Six month follow-up included a neuropsychological te...
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Papers by Carolyn Baum