Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine preliminary evidence of the response to intervention and whether a Phase III study should be completed to test efficacy of the combined intervention. The functional impact of improving poststroke upper limb performance could benefit millions of stroke survivors. Primary Author and Speaker: Christine Griffin Contributing Authors: Marcia Bockbrader, Erinn Hade, Anne Kloos, John A. Buford

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This poster will discuss the use of commercially available accelerometers to monitor poststroke home rehabilitation of the upper extremity during repetitive, occupation-based exercises. Secondary data analysis of outputs includes (1) comparison of self-reported practice sessions with sessions captured via the accelerometer, (2) comparison of self-reported practice time versus time captured via accelerometer, and (3) patterns in angular velocity based on data processing. Primary Author and Speaker: Kate De Castro Additional Authors and Speakers: Elena Donoso Brown Contributing Authors: Sarah Wallace, Rachael Neilan

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This research examined how client and health care factors affected OT outcomes for clients. A quantitative study was conducted with consecutive sampling of more than 200 participants with upper extremity (UE) conditions over an 18-month period. UE therapy outcomes were assessed every 4 weeks using Global Rate of Change (GROC) and QuickDASH scores, which both improved significantly. This study can inform OTs working with outpatient clients about factors that can affect decisions regarding treatment implementation. Primary Author and Speaker: Cindy Hayden

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Hand–Object Observation Tool is a valid systematic observational tool developed to measure upper extremity functioning in children with bilateral cerebral palsy. Using a valid systematic strategy to observe hand–object interaction during daily activities provides clinicians with the much-needed information regarding upper extremity function and optimal object placement to facilitate hand use, task completion, and participation in daily activities. Primary Author and Speaker: Amanda Sarafian Contributing Authors: Katherine Dimitropoulou, Madhabi Chatterji, and Andrew Gordon

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The PRESS to Function Approach is designed to provide a systematic method of evaluating upper extremity function of musculoskeletal disorders. It is based on six constructs: pain, range of motion, edema, strength, sensibility, and functional ability. The approach avoids rendering incomplete hand and upper extremity evaluations and reassessments. The acronym is catchy enough for the novice therapist to make a mental check of what areas may be relevant during the session. Primary Author and Speaker: Phyllis Ross Additional Authors and Speakers: Felecia Banks

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine preliminary evidence of the response to intervention and if a Phase III study should be completed to test efficacy of the combined intervention. The functional impact of improving post stroke upper limb performance could benefit millions of stroke survivors. Primary Author and Speaker: Christine Griffin Contributing Authors: Marcia Bockbrader, Erinn Hade, Anne Kloos, and John A. Buford

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In acute care, discharge planning is a primary role of OT for clients with arm impairment after stroke. Discharge planning accounts for many factors, including impairments, function, social supports, insurance, and the input of other disciplines. This research aimed to (1) determine the agreement in discharge recommendations between OT and physical therapy during acute hospitalization and (2) determine the agreement of OT recommendation and actual discharge setting for clients with arm impairment after stroke. Primary Author and Speaker: Nicole C. Lam Contributing Authors: Kimberly Erler, Jessica Ranford, Jessica D. Asiello, Kimberly Cortina, Natasha Frazier, Abigail Rude, Caitlin Sadlak, Helena Thorne, Rachel Collins, Erin E. Donovan, Sarah Norris, and David Lin

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This mixed-methods case study examines use of a harness system in a community garden for persons poststroke.No studies exist on this topic. Two persons participated.Multiple pretest–posttest measures, observations, and poststudy interviews were conducted. Both showed improvement in balance and mobility, and Person 2's spirituality improved. Persons described enhanced confidence in functional mobility, ability to problem solve, and use of the hemiplegic upper extremity. Research in natural environments is needed. Primary Author and Speaker: Beth Ekelman Contributing Authors: Kelly Bishop, Erica Hughes, Allison Kienzle, Alicia Loreta, Marissa Melaragno, Shay Smallman, Jason Uth, Morgan Vaughn, and Jessica Zdanowicz

Date Presented 04/21/21 Evidence-based approaches to upper extremity motor recovery emphasize the use of repetitive-task practice strategies incorporating motor learning principles. These approaches, however, are not consistently implemented in practice. Understanding factors related to the practitioner, the client, the practice setting, and the therapeutic interaction that influence a practitioners' clinical decision making reveals strategies that may help decrease this research-to-practice gap. Primary Author and Speaker: Shannon L. Scott Additional Authors and Speakers: Morgan Sanei Contributing Authors: Leora Comis, Rafael Jimenez Silva, and Smita Jha

Date Presented 04/9/21 This presentation will describe pilot findings of a novel protocol, the Active Learning Program for Stroke, in which cognitive strategy training is used to facilitate the transfer of robot-trained motor skills to upper limb performance in the home and community. This protocol is relevant to clinical practice with and without robotic technology because it provides clinicians with a structured, client-centered motor learning approach to optimize functional use of the paretic arm and hand after stroke. Primary Author and Speaker: Susan E. Fasoli Contributing Authors: Sarah L. Smith

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Upper extremity (UE) functional recovery after stroke requires the integration of motor and sensory systems. We describe the relationship among recovery of somatosensation, motor impairment, and manual dexterity from acute to 3 months poststroke. Sensory retraining emphasized in conjunction with motor interventions after stroke may improve functional UE outcomes. Primary Author and Speaker: Isha Vora Contributing Authors: David Lin, Julie DiCarlo, Jessica Ranford, and Teresa J. Kimberley

Importance: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. Objective: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. Design: Randomized, crossover-controlled, assessor-blinded study. Setting: Rehabilitation clinic. Participants: Patients (N = 24) with moderate motor and sensory deficits. Intervention: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. Outcomes and Measures: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment–Upper Extremity (FMA–UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes–Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. Results: RT resulted in significantly improved FMA–UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants’ EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). Conclusions and Relevance: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. What This Article Adds: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

Importance: Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. Objective: To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. Data Sources: PubMed and Embase (1900–2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. Study Selection and Data Collection : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. Findings: Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. Conclusion and Relevance: The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. What This Article Adds: This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.

OBJECTIVE. We sought to determine the reliability of the Fitbit^® Flex™ compared with the ActiGraph^® Bluetooth^® Smart wGT3X-BT wireless activity monitor and to contribute to the clinical utility of accelerometry measurement of upper extremity (UE) movement. METHOD. Two studies were conducted at different sites with healthy adult participants. In Study 1, participants wore both accelerometers on both wrists during everyday activities for a 24-hr period. In Study 2, participants wore both accelerometers on the dominant wrist for 4 hr during an active period of the day. All participants wore the accelerometers during regular daily activities. RESULTS. Data recorded from the Fitbit and the ActiGraph showed a high positive correlation; however, the Fitbit recorded significantly fewer movements than the ActiGraph. CONCLUSION. Although the Fitbit and the ActiGraph measure UE activity similarly, the Fitbit was not as sensitive as the ActiGraph. This study provides informative data on the clinical utility of the Fitbit compared with the ActiGraph.

OBJECTIVE. We compared the feasibility of, adherence to, and satisfaction with a newly developed upper extremity (UE) self-training protocol using commercial video games with a traditional self-training program for people with chronic stroke. METHOD. Twenty-four participants with mild to moderate UE weakness were randomized to a video game (n = 13) or traditional (n = 11) self-training program. Participants were requested to train 60 min/day, 6×/wk. During the 5-wk self-training program and 4-wk follow-up, participants documented their self-training time and rated their perceived enjoyment and exertion. RESULTS. Eleven participants completed video game training; 9 completed traditional self-training. During the follow-up period, 8 participants (72.7%) continued the video game training, and 4 (44.4%) continued traditional training. Perceived enjoyment, satisfaction, and benefit for UE improvement were relatively high. CONCLUSIONS. Participants demonstrated high adherence to and satisfaction with both self-training programs. More participants continued to play video games after the intervention, indicating its potential to maintain ongoing activity.

OBJECTIVE. We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD. In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS. The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION. The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

The extant literature suggests the Lee Silverman Voice Treatment BIG^® (LSVT BIG) program is an effective intervention for persons with Parkinson’s disease; however, no literature or research on the use of this program as an intervention for persons with stroke exists. We examined the effects of the LSVT BIG program for a 52-yr-old community-dwelling woman with mild to moderate upper extremity hemiparesis 2 yr after a stroke and the feasibility of delivering the home exercise component of the program in a game-based format. We made measurements at pretest, posttest, and 6-wk follow-up. The participant demonstrated self-reported improvements in occupational performance and satisfaction and large improvements in upper extremity motor function. The next step in this research is to deliver LSVT BIG and a home game-based program with a larger, more diverse population of persons with chronic stroke to further determine the effectiveness and appropriateness of this intervention.

This secondary analysis quantified the psychometric properties of the Ohio Modified Arm–Motor Ability Test (OMAAT) in a sample of neurologically stable chronic stroke survivors (n = 67, 40 men; mean age 59.8 yr, standard deviation = 12.8; 42 White, 23 Black, 2 other; 92.5% right-sided lesion; 44 ischemic stroke). Findings indicate high OMAAT internal consistency (Cronbach’s α = .97, ordinal α = .98, Gugiu’s bootstrap reliability = .97), unidimensionality, and strong positive factor loadings for all 20 OMAAT items. Convergent validity between OMAAT and Action Research Arm Test total scores was strong (r = .90, p < .0001). The OMAAT is the first short measure of upper extremity functional limitation available to clinicians and researchers that includes an administration manual and that has been examined using nonparametric psychometrics. A detailed administration manual is provided as a supplement to this article.

OBJECTIVE. Our objective was to determine the effect of loss of body sensation on activity participation in stroke survivors. METHOD. Participants (N = 268) were assessed at hospital admission for somatosensory and motor impairment using the National Institutes of Health Stroke Scale. Participation was assessed using the Activity Card Sort (ACS) in the postacute phase. Between-group differences in activity participation were analyzed for participants with and without somatosensory impairment and with or without paresis. RESULTS. Somatosensory impairment was experienced in 33.6% of the sample and paresis in 42.9%. ACS profiles were obtained at a median of 222 days poststroke. Somatosensory loss alone (z = 1.96, p = .048) and paresis in upper and lower limbs without sensory loss (z = 4.62, p < .001) influenced activity participation. CONCLUSION. Somatosensory impairment is associated with reduced activity participation; however, paresis of upper and lower limbs can mask the contribution of sensory loss.

OBJECTIVE. The purpose of this study was to understand the age-related changes, adaptations, and contexts that support older workers in the manufacturing sector. METHOD. In a multiple-case study, 10 older workers from two manufacturing companies completed the Job Content Questionnaire, Health and Productivity Questionnaire, and semistructured interviews and underwent task observations for 8 hr over 4 mo. RESULTS. Age-related changes affecting job tasks included near vision, upper extremity strength, grip strength, joint stiffness, and endurance. Older workers adapted job tasks by changing their work style, using equipment available, and relying on close coworkers for assistance. They adapted their personal lifestyle to maintain the energy necessary to meet job demands. Organizational contexts that supported older workers highlighted job control, social support, and mutual respect. CONCLUSION. This study suggests that occupational therapy practitioners can provide individualized adaptations, environmental modifications, and health promotion strategies to help older workers meet job demands while balancing work and home occupations.