Date Presented 04/22/21 Computer-based programs, conventional cognitive rehabilitation, neurologic music therapy, and noninvasive brain stimulation are effective in improving memory and learning, processing speed, language, executive function, or general cognitive skills. However, the retention of treatment effects and the generalizability of the cognitive improvement to the daily occupations are not clear. Including a predetermined single outcome, functional and long-term outcomes are needed in future studies. Primary Author and Speaker: Yu-Chih Chen Contributing Authors: Nicole Gerhardt, Christina Calhoun Thielen, Winnie Dunn, and Mary Jane Mulcahey

Importance: Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson’s disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD. Objective: To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD. Data Sources: MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1–3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy–related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation. Conclusions and Relevance: Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.

This article discusses the use of occupational therapy in the home setting and the individual application of treatment methods. Three case studies are presented that involve adults with acquired brain injury with memory deficits. The treatment methods used were (a) saturational cuing with behavioral chaining and positive reinforcement, (b) a coordinated team approach incorporating family or significant others and other therapists, and (c) environmental adaptations. A decision-making model and the dynamic assessment approach were used as a framework for treatment planning. The treatment technique chosen depended on the skill to be learned and the patient’s learning style. Each case required the selection of environmental adaptations including (a) use of family and attendants as cotherapists; (b) a tape-recorded message, played daily; and (c) an appointment book for daily things to do. Each case demonstrated prolonged therapy for skill acquisition with this patient population.

A theoretical model that provides a foundation for understanding function and dysfunction in cognition and perception is needed as a prerequisite for the development of effective assessment and treatment tools to be used with the brain-injured adult. Such a model and clear definitions are absent in the occupational therapy literature on adult brain function and dysfunction. This paper represents a cognitive rehabilitation model adapted for occupational therapy from the fields of neuropsychology and cognitive psychology. Differentiation of terms, an overview of the model’s theory, and evaluation principles are discussed. Cognitive rehabilitation is presented from an information processing perspective. Three other treatment approaches identified in the literature are discussed and compared with cognitive rehabilitation.