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craniocerebral trauma
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Journal Articles
The American Journal of Occupational Therapy, 1997, Vol. 51(5), 352–359.
Published: 01 May 1997
Abstract
Objectives. Off-road evaluations composed of psychometric testing and simulator driving are commonly used in rehabilitation settings to assess a person's fitness to resume driving after a cerebral injury. Although the results of these evaluation methods separately provide information about ability to drive, there is no clear understanding about what is measured in comprehensive off-road evaluations as a whole. This study explored the interrelationship of perceptual, cognitive, behavioral, and operational variables that form the basic for off-road evaluations in order to determine whether there are basic dimensions underlying performance in these evaluations and to derive a small set of variables that could help in refining methods for evaluating persons with cerebral injuries. Methods. One-hundred six persons with cerebral damage due to brain injury or cerebrovascular accident were administered a predriver evaluation that consisted of selected neuropsychometric tests. Subjects were also evaluated in a driving simulator that measured their operational responses to filmed driving situations and assessed their behaviors. Principal component analysis was used to identify manifest and latent variables contributing to the results of the evaluations. Results. The analysis produced a model with five independent (orthogonal) eigenvectors, or factors, for this population: Higher Order Visuospatial Abilities, Basic Visual Recognition and Responding, Anticipatory Braking, Defensive Steering, and Behavioral Manifestations of Complex Attention. These factors accounted for 66.14% of the total variance in the subjects’ responses to comprehensive off-road evaluations. Conclusion. These factors were useful in understanding driving performance and the role of predriver and simulator testing in driver evaluations.
Journal Articles
The American Journal of Occupational Therapy, 1996, Vol. 50(7), 535–544.
Published: 01 July 1996
Abstract
Objectives. This study explored the disruption of gender identity and gender role as a result a traumatic brain injury (TBI). Method. Four adults (two men, two women) who sustained a TBI between the ages of 18 and 30 years and were at least 1 year postinjury participated in six 1-hr interviews concerning changes in (a) perceived masculinity or femininity, (b) involvement in intimate relationships, (c) enactment of gender roles, and (d) organization of activities that support gender roles. Results. The men expressed greater feelings of gender inadequacy postinjury than did the women and appeared to have greater difficulty resolving rites of passage (e.g., achievement of the adult work role, marriage, parenting) and developmental issues characteristic of the life stage at which they experienced their injury. The men appeared to depend more heavily on traditional gender-specific activities before and after injury to define and support gender role; the women relied more on cross-gender activities. The women appeared to be able to maintain more preinjury activities postinjury than did the men. Conclusion. Postinjury possession of a personally satisfying sense of gender appears to be related to the ability to maintain much of the preinjury activities that defined and supported the participants’ sense of masculinity or femininity. The ability to satisfactorily resolve rites of passage or developmental issues characteristic of the life stage at which the brain injury occurred appears to be related to the ability to participate in activities that define and express gender role during that particular life stage.
Journal Articles
The American Journal of Occupational Therapy, 1996, Vol. 50(4), 306–314.
Published: 01 April 1996
Abstract
Two life history interviews were conducted to discover how one woman, Jenny, experienced a traumatic head injury, rehabilitation, and recovery. Narrative analysis of the transcribed interviews revealed a rich story of how Jenny had fashioned her identity and character through childhood occupations, including studying classical literature and music, and of how she drew upon resources developed in childhood to engineer her recovery. It also illustrated how Jenny used a recursive process of narrative construction and engagement in self-devised graduated occupations, including studying, playing music, writing, computer graphics, and theater production, to create a new identity and develop capacities to process complex information and exercise creativity. Jenny’s story illustrates the usefulness of gaining a perspective on patients as occupational beings through the gathering of life histories focused on occupation, the importance of collaborative patient-therapist goal setting, and the necessity for considering both the doing (practic) and the meaning (narrative) aspects of occupation. Her story supports many scholars’ arguments that the therapeutic relationship, and thus occupational therapy practice, may be enhanced through the use of life history interviewing in occupational therapy evaluation and treatment.
Journal Articles
The American Journal of Occupational Therapy, 1996, Vol. 50(3), 223–228.
Published: 01 March 1996
Journal Articles
The American Journal of Occupational Therapy, 1995, Vol. 49(10), 986–993.
Published: 01 November 1995
Abstract
Objectives. Burnout has been linked to job retention in occupational therapy, physical therapy, and other health professions. Professional development activities are often suggested to reduce burnout, but little empirical evidence supports this contention. This study explored the prevalence of burnout among occupational and physical therapists working in head injury rehabilitation and evaluated the relationship between burnout and professional development activities. Method. Forty therapists working full-time in head injury rehabilitation were surveyed. Correlations between subscale scores of the Maslach Burnout Inventory (i.e., Emotional Exhaustion, Depersonalization, and Personal Accomplishment) and responses to a survey of professional development activities are reported. Results. Professional development activities are most strongly associated with feelings of personal accomplishment. Emotional exhaustion was relatively high among these therapists, but few feelings of depersonalization were evident. Conclusions. Professional development activities in the workplace may augment feelings of personal accomplishment and minimize burnout as an issue in job retention. Strategies to effectively identify and manage therapists’ feelings of emotional exhaustion require further study.
Journal Articles
The American Journal of Occupational Therapy, 1994, Vol. 48(4), 305–309.
Published: 01 April 1994
Abstract
Objectives. A follow-up study of the support group discussed in Schwartzberg’s 1994 study was conducted to determine participants’ perceptions of helping factors in the group. Method. Subjects were given a semistructured interview; follow-up interviews were held to ensure accuracy. Results. Eleven helping factors were spontaneously generated from group members’ data. These factors were socializing; finding out other people’s perspectives and attitudes; expressing thoughts and feelings; receiving support; feeling something in common with other group members; gaining understanding, empathy, and acceptance through listening and sharing; getting perspective by learning about other people’s limitations and strengths; helping others; getting help with problem solving; feeling hope; and learning information about brain injury. Members ranked expressing thoughts and feelings as the most helpful factor and finding out other people’s perspectives and attitudes as the least helpful. Conclusions. These results support Schwartzberg’s earlier findings, with some exceptions. The factor titles in this study have a broader scope than those in Schwartzberg’s study, and not all of the factors determined in this study are completely comparable to Schwartzberg’s factors. These findings may indicate that some differences in perspective exist between the participant observer and the survivors in the group studied.
Journal Articles
The American Journal of Occupational Therapy, 1994, Vol. 48(4), 297–304.
Published: 01 April 1994
Abstract
Objectives. An ethnographic study of a peer-developed support group for persons with head injury was conducted to identify helping factors. These factors are the peer group experiences and processes, established theoretically and empirically, that provide support through self-help. Method. The group comprised 13 members who regularly attended sessions for 16 months. In addition to participant observation, the data included audiotapes and videotapes of the group. The data were subjected to thematic analysis to find patterns in the participants’ experience with regard to group helping factors. Results. Many of the positive attributes of the group seem similar to processes found in successful peer support groups. These attributes include believing and feeling part of the group because members have a common problem and can validate the effects of the injury by sharing and receiving information in a variety of ways through the group. Conclusion. Legitimization, the acceptance of the head injury itself as real, appears to be the fundamental concept that distinguishes this group from other problem-focused self-help groups and professionally led groups.
Journal Articles
The American Journal of Occupational Therapy, 1993, Vol. 47(5), 444–451.
Published: 01 May 1993
Abstract
This report describes a customized self-feeding system designed to increase the independence of a person with a head injury who is unable to use his arm for self-feeding. The client has spastic hemiparesis in the right upper extremity and profound ataxia in the left upper extremity. Due to the severity of these disabilities, the client required total assistance at every meal since his injury 6.5 years ago. The self-feeding system described consists of an adapted spoon, a spoon holder, a scoop dish, and a dish stand. The client scoops food from the scoop dish with the adapted spoon held in his mouth and then transfers the spoon to a magnetic holder for positioning. This adaptation allows the client to position the spoon with his chin without demanding fine motor coordination. The self-feeding system is evaluated with a BAB single case research withdrawal design. Results indicate that this self-feeding system provides a viable alternative to assisting independence in self-feeding as measured by the cost benefit ratio and nutrition intake. The client used the self-feeding system for 12 months at the rehabilitation center and has continued using the equipment at his nursing home.
Journal Articles
The American Journal of Occupational Therapy, 1993, Vol. 47(5), 391–396.
Published: 01 May 1993
Abstract
Rehabilitation specialists, particularly occupational therapists, are often involved in evaluating clients’ fitness to resume driving after cerebral damage due to head injury or stroke. Their available methods include separate or combined administration of predriver, simulator, and behind-the-wheel evaluations. However, use of these methods without a theoretical model on which to base test selection has yielded some criticism and little research about the effectiveness of these methods in predicting driving performance. Using the authors’ Cybernetic Model of Driving as the basis for assessing abilities and behaviors relevant to driving outcome, this study sought to determine the effectiveness of the evaluation methods by discriminant analysis and measurements of sensitivity in predicting behind-the-wheel failures. Comprehensive evaluations of 106 patients revealed that residual deficits in cognition per se did not render a person unfit to drive and underscored the importance of considering behaviors in determining fitness. The methods of evaluation were shown to be relatively sensitive in predicting outcome; off-road and on-road evaluation reached sensitivities of 90% and 92% with the inclusion of behavioral measures. Formulae for predicting outcome based on methods of evaluation are provided and reasons for failures in behind-the-wheel evaluations are discussed.
Journal Articles
The American Journal of Occupational Therapy, 1992, Vol. 46(4), 324–332.
Published: 01 April 1992
Abstract
Evaluation of the ability of cerebrally injured patients to return to driving is an important task for rehabilitation specialists. These evaluations require predictively valid methods of assessment based on identification of relevant skills and abilities. The present study tested a hypothetical model for driving after cerebral injury and determined its use in evaluating fitness to drive. Thirty-five patients with cerebral damage due to head injury or cerebrovascular accident participated in the study. All were administered (a) a predriver evaluation, that is, a battery of neuropsychological tests chosen a priori to test the model, (b) a simulator evaluation, and (c) a behind-the-wheel evaluation consisting of driving on a protected course and in traffic. The results showed that 93% of the driving outcome in traffic was explained cumulatively by findings from the predriver and simulator evaluations as well as from behavioral and operational measures during evaluation on the protected lot. These results supported the predictive validity of the model and are discussed in terms of methodology for evaluation of return to driving.
Journal Articles
The American Journal of Occupational Therapy, 1992, Vol. 46(3), 267–270.
Published: 01 March 1992
Journal Articles
The American Journal of Occupational Therapy, 1992, Vol. 46(2), 163–166.
Published: 01 February 1992
Journal Articles
The American Journal of Occupational Therapy, 1992, Vol. 46(2), 141–148.
Published: 01 February 1992
Abstract
Occupational therapists use both adaptive and remedial approaches to perceptual retraining in adults with head injury. This experimental treatment outcome study compared the effects of adaptive and remedial treatments for constructional deficits on meal preparation competence and on constructional abilities in adult men with head injury. Forty-five subjects, 18 to 52 years of age, in long-term rehabilitation programs were randomly assigned to one of two treatment groups. A remedial group (n = 22) received individual training with parquetry block assembly, and an adaptive group (n = 23) received individual training in food preparation activities. Both groups received training for three 30-min sessions per week for 6 weeks, in addition to their regular rehabilitation programs. Results of analyses of variance and paired t tests on perceptual and functional test scores showed task-specific learning in both groups and suggested that training in functional activities may be the better way to improve performance in such activities in this population.
Journal Articles
The Use of Relaxation Training to Enhance Functional Outcomes in Adults With Traumatic Head Injuries
The American Journal of Occupational Therapy, 1990, Vol. 44(9), 797–802.
Published: 01 September 1990
Abstract
Impaired anxiety management and poor emotional control have a negative effect on the adaptive functioning of persons with head injuries who are in the postacute stages of recovery. This paper outlines a relaxation training program administered individually to 4 adults with severe head injuries. Each subject was in the postacute phase of recovery and had reported stress to be a persistent problem in daily living. The relaxation training protocol combined biofeedback, imagery, autogenic training, and deep breathing. Significant improvement in function, measured by scores on a scale of illness-related dysfunction, support the potential benefits of stress management training as part of functional training programs for persons with traumatic head injuries.
Journal Articles
The American Journal of Occupational Therapy, 1990, Vol. 44(8), 709–713.
Published: 01 August 1990
Abstract
The evaluation of the ability of patients to return to driving after cerebral damage stands out as one of the most important tasks confronted by rehabilitation professionals. The present study was designed to critically assess evaluations that were developed at one facility to determine fitness to drive: an off-road, predriver evaluation of skills regarded as important in driving and an on-road, behind-the-wheel evaluation of abilities needed to drive in actual traffic situations. The evaluation results of 37 patients with cerebral damage due to traumatic head injury or cerebrovascular accident were studied retrospectively. Only 4 out of 21 items on the predriver evaluation significantly predicted the outcome of the predriver evaluation and none of the predriver evaluation items predicted the outcome of the behind-the-wheel evaluation. Only 6 of the 26 tasks on the behind-the-wheel evaluation significantly predicted the outcome of the behind-the-wheel evaluation. None of the items on the predriver evaluation or the behind-the-wheel evaluation explained a significant portion of variance related to outcome. The lack of internal and predictive validity of driver evaluations is discussed in light of these findings, and recommendations are given for improving the predictive power of driving evaluations.
Journal Articles
The American Journal of Occupational Therapy, 1989, Vol. 43(3), 184–192.
Published: 01 March 1989
Abstract
The purpose of this study was to determine the reliability and validity of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery. The battery provides an initial profile of the cognitive abilities of the brain-injured patient that can be used as a starting point for occupational therapy intervention and as a screening test for further assessment. The LOTCA consists of 20 subtests and is divided into four areas: orientation, visual and spatial perception, visuomotor organization, and thinking operations. The battery takes 30 to 45 minutes to administer. Subjects in the study consisted of two patient groups (20 traumatic head injury patients and 28 cerebrovascular accident patients) and one control group (55 non-brain-injured adults). Results showed interrater reliability coefficients of .82 to .97 for the various subtests and an alpha coefficient of .85 and above for the internal consistency of the areas of perception, visuomotor organization, and thinking operations. The Wilcoxon two-sample test showed that all subtests differentiated at the .0001 level of significance between the patient groups and the control group. This supported the LOTCA’s validity. Furthermore, factor analysis provided initial construct validation for three areas of the battery: perception, visuomotor organization, and thinking operations.
Journal Articles
The American Journal of Occupational Therapy, 1987, Vol. 41(7), 461–464.
Published: 01 July 1987
Journal Articles
The American Journal of Occupational Therapy, 1981, Vol. 35(7), 438–442.
Published: 01 July 1981
Abstract
The purpose of this study was to explore the potential relationship between dressing ability and constructional praxis performance in a head-injured population. Thirty-seven patients with severe head injuries were rated on dressing ability and constructional praxis tasks in a rehabilitation setting. Three constructional praxis measures were taken: graphic, two-dimensional, and three-dimensional abilities. A significant relationship was found between mean dressing ability scores and all three constructional praxis scores. These findings suggest that a portion of inability to dress is perceptual, not motor, in origin in individuals with severe head-injuries, and that constructional praxis re-training has functional significance for the patient. No relationship was found between presence or absence of Computerized Axial Tomography (CAT scan) abnormality and dressing or constructional praxis disability.