Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The goal of this poster is to provide information and foster conversation about the development, clinical use, and content validity of the Occupational Therapy Anticipatory Awareness Test (OTAAT). The OTAAT is a newly developed, performance-based assessment tool that addresses a gap in the assessment of anticipatory awareness for individuals with neurological conditions. Discussion about participation in future research and validation processes will be facilitated. Primary Author and Speaker: Danielle Mahoney Additional Authors and Speakers: Lenin Grajo, Glen Gillen

Health care spending in the United States continues to grow at an unsustainable rate. In 2015, spending increased 5.8%, to reach $3.2 trillion, or $9,990 per person. As a share of the nation’s gross domestic product, health spending accounted for 17.8% (Morgan et al., 2016). A critical component of addressing this issue is eliminating wasteful spending without reducing quality and appropriate care. In 2012, Choosing Wisely^®, an initiative of the ABIM Foundation (American Board of Internal Medicine), started with the aim to encourage meaningful conversations between health care practitioners and clients to ensure that appropriate and quality care is being provided. The American Occupational Therapy Association (AOTA) made a commitment to join Choosing Wisely in 2016. With support and input from AOTA members, the Board of Directors, and staff, AOTA implemented a three-phase process to develop and publish the list, “Five Things Patients and Providers Should Question.” The goal of AOTA’s participation in this initiative is to start dialogue within the occupational therapy profession about providing quality services that are supported by evidence, not duplicative, free from harm, and truly necessary.

Date Presented 3/31/2017 Stroke survivors can have spatial neglect and movement deficits. Few studies examine effects of spatial treatments on motor function or recruit people with multiple strokes. This study concluded that prism adaptation treatment is feasible and effective in improving spatial neglect and arm movement. Primary Author and Speaker: Kimberly Hreha Contributing Authors: Glen Gillen

Date Presented 4/8/2016 Mirror therapy (MT) is used in practice; however, no studies have compared the two MT protocols for upper-limb recovery. This pilot study is an important step in deciphering the superiority of the available protocols and furthers our knowledge regarding best practice for the use of MT in recovery poststroke. Primary Author and Speaker: Daniel Geller Contributing Authors: Dawn Nilsen, Glen Gillen, Steve Vanlew, Matthew Bernardo

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice project. The clinical condition discussed in this inaugural Evidence Connection article is adults with stroke. Findings from the systematic reviews on this topic were published in the January/February 2015 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Adults With Stroke ( Wolf & Nilsen, 2015 ). Each article in this series will summarize the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

Although rapid progress has been made in generating evidence to support occupational therapy interventions for clients who survive a stroke, the areas receiving research attention show a lack of balance that researchers should correct in order to better guide practice.

We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.

This evidence-based review was conducted to determine which interventions are effective in improving occupational performance after stroke. Forty-six articles met the inclusion criteria and were examined. Interventions for the following impairments were reviewed: general cognitive deficits, executive dysfunction, apraxia, memory loss, attention deficits, visual field deficits (included because of their close relationship with neglect), and unilateral neglect. Evidence is available from a variety of clinical trials to guide interventions regarding general cognition, apraxia, and neglect. The evidence regarding interventions for executive dysfunction and memory loss is limited. There is insufficient evidence regarding impairments of attention and mixed evidence regarding interventions for visual field deficits. The effective interventions have some commonalities, including being performance focused, involving strategy training, and using a compensatory as opposed to a remediation approach. The implications of the findings for practice, research, and education are discussed.

At times on our collective professional journey, occupational therapy practitioners have begun to lose sight of and confidence in our methods, including intervention and assessment approaches; these proverbial “forks in the road” may have led practitioners away from professed and philosophical occupational therapy methods.

The occupational therapy profession has put forth a vision for evidence-based practice. Although many practitioners express a commitment to the provision of services informed by evidence, the reality that tradition still determines much of our education, certification, and practice cannot be ignored. In this article, we highlight the disconnect between the profession’s aspirations and actual practices using neurophysiological models as an example. We describe actions to actualize the shift from traditional interventions to evidence-based approaches. We challenge readers to become agents of change and facilitate a culture shift to a profession informed by evidence. It is our hope that this article will provoke critical discourse among educators, practitioners, authors, and editors about why a reluctance to let go of unsubstantiated traditions and a hesitancy to embrace scientific evidence exist. A shift to providing evidence-based occupational therapy will enable us to meet the objectives of the Centennial Vision.

OBJECTIVE. This preliminary study sought to determine whether the imagery perspective used during mental practice (MP) differentially influenced performance outcomes after stroke. METHOD. Nineteen participants with unilateral subacute stroke (9 men and 10 women, ages 28–77) were randomly allocated to one of three groups. All groups received 30-min occupational therapy sessions 2×/wk for 6 wk. Experimental groups received MP training in functional tasks using either an internal or an external perspective; the control group received relaxation imagery training. Participants were pre- and posttested using the Fugl-Meyer Motor Assessment (FMA), the Jebsen–Taylor Test of Hand Function (JTTHF), and the Canadian Occupational Performance Measure (COPM). RESULTS. At posttest, the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF (p < .05). All groups improved on the COPM (p < .05). CONCLUSION. MP combined with occupational therapy improves upper-extremity recovery after stroke. MP does not appear to enhance self-perception of performance. This preliminary study suggests that imagery perspective may not be an important variable in MP interventions.

OBJECTIVE. We sought to determine whether mental practice is an effective intervention to improve upper-limb recovery after stroke. METHOD. We conducted a systematic review of the literature, searching electronic databases for the years 1985 to February 2009. We selected studies according to specified criteria, rated each study for level of evidence, and summarized study elements. RESULTS. Studies differed with respect to design, patient characteristics, intervention protocols, and outcome measures. All studies used imagery of tasks involving movement of the impaired limb. The length of the interventions and number of practice hours varied. Results suggest that mental practice combined with physical practice improves upper-limb recovery. CONCLUSION. When added to physical practice, mental practice is an effective intervention. However, generalizations are difficult to make. Further research is warranted to determine who will benefit from training, the dosing needed, the most effective protocols, whether improvements are retained, and whether mental practice affects perceived occupational performance.

The emotional impact of surviving a stroke has not received the same attention as physical aspects. This is particularly true regarding how stroke survivors cope during inpatient rehabilitation. This study examined the coping strategies used by stroke survivors undergoing inpatient rehabilitation and the relationships between demographic or clinical variables and coping behaviors. This case series examined 16 acute stroke survivors via standardized assessments and a medical records review completed during the first week of inpatient rehabilitation. Stroke survivors used combinations of multiple coping strategies. All stroke survivors used a higher number and frequency of adaptive rather than maladaptive strategies. Women used a higher number of adaptive strategies. Stroke survivors with depression used maladaptive coping strategies more frequently, whereas those presenting with a greater number and severity of comorbidities used adaptive coping strategies more frequently. Stroke survivors with higher levels of coping self-efficacy used the strategies of active coping and positive reframing more frequently. Based on these results, it is recommended direct-care providers place greater emphasis on objectifying the emotional consequences of stroke. Further research is recommended regarding understanding the relationship between coping and outcomes.

This exploratory study focused on gaining insight into the psychological experience of stroke survivors undergoing inpatient rehabilitation. Specifically it investigated whether stroke survivors undergoing inpatient rehabilitation were able to identify any positive consequence of their stroke. This phenomenon, also know as benefit finding or positive reframing, has recently received more attention in the coping literature examining reactions to severe illness. Using a case series methodology and qualitative analytic techniques, 16 stroke survivors were interviewed using standardized open-ended questions related to identification of positive consequences attributed to surviving a stroke. Sixty-three percent of the patients interviewed were able to identify positive consequences of their stroke. The following five themes regarding positive consequences of stroke emerged from this case series: increased social relationships, increased health awareness, change in religious life, personal growth, and altruism. It was concluded that some individuals who have survived an acute stroke are able to reframe their experience in a positive light. This study provides occupational therapists and others with further insight into the coping mechanisms of those individuals who have survived a stroke. The need for further research is stressed.

This case report summarizes the evaluation and treatment used to provide occupational therapy services to a man living with multiple sclerosis. Primary impairments included ataxia, paraparesis, and decreased endurance. The focus of this case study was on improving the client’s ability to use powered mobility to access the community despite severe ataxia. A task-oriented approach was used as a frame of reference to guide the evaluation and intervention process. The primary goals of intervention were to control the degrees of freedom required for task participation and simultaneously increase postural stability, resulting in independent control of a power wheelchair. A combination of occupational therapy interventions is illustrated, including assistive technology, positioning, orthotic prescription, and adaptation of movement patterns.