2015-801Cognitive Rehabilitation and Traumatic Brain Injury: Invisible Barrier to Competitive

Rehab & Disability

Employment?

Rehab & DisabilityPostersIntermediate to topic

By viewing this poster and interacting with the presenters, participants will be able to:

1.Describe the methodology for completing an evidence based practice review.

2.Describe and discuss the current and relevant literature regarding the use of cognitive rehabilitation and its relationship to traumatic brain injury and return to competitive employment.

3.Identity and discuss future research topics relating to cognitive rehabilitation which will advance the role of occupational therapy in this area.

This poster is designed to provide occupational therapists with an overview of evidence based research and treatment procedures necessary to answer the following question: Does cognitive rehabilitation increase the rate of returning to work in competitive employment settings for individuals living with traumatic brain injury? The research reported in this study supports the use of cognitive rehabilitation in restoring competitive employment for patients with TBI. Although living with a TBI will inevitably impact an individual in many areas of life, long-term functional improvement is likely to occur. Research reports that greater gains in both physical and cognitive functions are made through a multidisciplinary, wide-ranging, comprehensive approach to rehabilitation. Return to work (RTW) programs have been found to be beneficial when emphasizing cognitive rehabilitation for those who have sustained a TBI. Additionally, cognitive rehabilitation has been reported to improve self concept, interpersonal relationships, memory, and to decrease anxiety. These are all important skills needed when returning to work and may be applied to a client living with any level of TBI. The cognitive rehabilitation approach is utilized by both occupational therapists and related health professionals to support, modify, adapt or restore performance skills necessary for the performance area of returning to work. To date, the majority of studies focusing on return to work have been conducted by professions other than occupational therapy. A major concern in the field of occupational therapy is the lack of research focusing specifically on occupational therapy intervention. Return to work is represented as a performance area in the Occupational Therapy Practice Framework III. It is highly recommended that further studies be conducted which focus on the effects of cognitive rehabilitation on returning to competitive employment for clients living with TBI.

References

Altman, I. M., Swick, S., Parrot, D., & Malec, J. F. (2010). Effectiveness of community-based

rehabilitation after traumatic brain injury for 489 program completers compared with those

precipitously discharged. Archives of Physical Medicine and Rehabilitation, 91, 1697-1704. American Occupational Therapy Association.(2014). Occupational therapy practice framework: Domain

and process. (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. Arciniegas, D., Held, K., & Wagner, P. (2002). Cognitive Impairment Following Traumatic Brain Injury.

Current Treatment Options in Neurology, 43-57.

Ben-Yishay, Y., & Diller, L. (1993). Cognitive remediation in traumatic brain injury: Update and issues.

Archives of Physical Medicine and Rehabilitation, 74, 204-213.

Ben-Yishay, Y, SM Silver, E Piasetzky, and J Rattok. (1987). "Relationship between employability and

vocational outcome after intensive holistic cognitive rehabilitation.” Journal Of Head Trauma Rehabilitation 2, no. 1: 35-48.

Bergquist, T. F., Boll, T., Corrigan, J. P., Harley, J. P., Malec, J. F., Millis, S. R., & Schmidt, M. F.

(1994). Neuropsychological rehabilitation: Proceedings of a consensus conference. Journal of

Head Trauma Rehabilitation, 9, 50-61.

Carney, N., Chesnut, R. M., Maynard, H., Mann, N. C., Patterson, P., & Helfand, M. (1999). Effect of

Cognitive Rehabilitation on Outcomes for Persons with Traumatic Brain Injury: A Systematic

Review. Journal of Head Trauma Rehabilitation, 14(3), 277-307.

Chesnut, R. M., Carney, N., Maynard, H., Mann, N. C., Patterson, P., & Helfand, M. (1999). Summary

Report: Evidence for the Effectiveness of Rehabilitation for Persons with Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 14(2), 176-188.

Curr Treat Options Neurol. 2002 Jan;4(1):43-57. Cognitive Impairment Following Traumatic Brain

Injury. D’siron, H. A., Rijk, A. D., Hoof, E. V., & Donceel, P. (2011). Occupational therapy and return to work: A systematic literature review. BMC Public Health, 11(1), 615.

Ghajar, J. (2000). Traumatic brain injury. The Lancet, 356(9233), 923-929. Hofgren, C., Esbörnsson,

E., & Sunnerhagen, K. (2010). Return to work after acquired brain injury: facilitators and hindrances observed in a sub-acute rehabilitation setting. Work, 36(4), 431-439.

Holzberg, E. (2001). The best practice for gaining and maintaining employment for individuals with

traumatic brain injury. Work, 16(3), 245-258. Labor Glossary. (n.d.). Retrieved from

Salazar, A. M. (2000). Cognitive Rehabilitation for Traumatic Brain Injury: A Randomized Trial. JAMA:

The Journal of the American Medical Association, 283(23), 3075-3081. TBI Research Review: Return to Work After Traumatic Brain Injury. (n.d.). Retrieved from

Tsaousides, T., & Gordon, W. A. (2009). Cognitive rehabilitation following traumatic brain injury:

Assessment to treatment. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine,76(2), 173-181.

Twamley, E. W., Jak, A. J., Delis, D. C., Bondi, M. W., & Lohr, J. B. (2014). Cognitive Symptom

Management and Rehabilitation Therapy (CogSMART) for Veterans with traumatic brain injury: Pilot randomized controlled trial. Journal Of Rehabilitation Research & Development, 51(1), 59-69.

Watanabe, S. (2011). Vocational rehabilitation for clients with cognitive and behavioral disorders

associated with traumatic brain injury. A Journal of Prevention, Assessment and Rehabilitation, 45(2), 273-277. What are common TBI symptoms? (n.d.). Retrieved from

The primary presenter for this poster is currently a graduate student in the Department of Occupational Therapy at xxxxxx. The content for this poster was developed as a requirement in a full semester course in Evidence Based Research. The faculty mentor for this project is a recognized expert in the evidence based process. The primary speaker presented this content in a public forum prior to the conference submission.

This poster is designed to provide occupational therapists with an overview of evidence based research and treatment procedures addressing cognitive rehabilitation, traumatic brain injury, and return to competitive employment.

2015-802Firing is Rewiring: Mental Practice's Role in Stroke Rehabilitation

Rehab & DisabilityPostersIntroductory to topic

1. Explain mental practice and the implications for practice.

2. Determine the benefits of using mental practice with traditional occupational therapy services.

3. Understand the importance of mental practice as a supplementary intervention.

Rehabilitation and disability have been recognized as the key practice areas in the 21st century by AOTA, guided by the centennial vision (AOTA, 2015). Rehabilitation is one of the core components of Occupational therapy. Our aim as OTs in this scope is to enable our clients to return to meaningful activities no matter the condition or setting. Stroke is one of the leading causes in adult disability. This study aims to prove the efficacy of mental practice as a supplemental intervention strategy combined with traditional OT services. Mental practice is the mental imagery of an activity as practice, working to successfully activate the same neural areas as the physical act. Information on this topic was limited and there is a need for more research to be done on the validity of using mental practice as a strategy as both a singular and supplemental intervention. The results of the research show that mental practice can have a significant impact on paretic upper extremities and increasing an individual's functional ability in that extremity. All information presented in this poster was gathered by completing a literature synthesis from the following sites: EBSCOHost, PubMed, AJOT, Google Scholar, CINHAL, OTSearch, and Proquest. This information is valuable to occupational therapy because it can allow us as practitioners to use the new and innovative methods of intervention to rehab our clients, quickly and effectively, allowing them to participate in meaningful activities.

American Occupational Therapy Association, Inc (2015). AOTA Retrieved from

xxxxxxxxx is a occupational therapy graduate student at the Xxxxx. He received his undergraduate degree in Exercise Science from Xxxxx. As a graduate student, he has completed multiple literature reviews and presentations in past and current course work on the benefits of mental practice in occupational therapy.

This presentation provides pertinent evidence on the efficacy of using mental practice in stroke rehabilitation as a supplementary intervention combined with traditional services and the beneficial impact it has on occupational therapy practice.

2015-803Assessments of Unilateral Neglect

Rehab & Disability50 minute sessionsIntermediate to topic

-Describe types of unilateral neglect List at least three assessments of unilateral neglect

-Describe the clinical utility of at least three standardized assessments of unilateral neglect

Occupational therapists are often primary team members in the identification and treatment of unilateral neglect. Surveys of therapists indicate that standardized assessments of unilateral neglect are not commonly employed in clinical practice. Trends in health care reimbursement require an increasing amount of data to justify services and support treatment outcomes. In this presentation, the syndrome of unilateral neglect will be reviewed, with a discussion of the subtypes of unilateral neglect and the impact on evaluation. Available assessments will be presented with a discussion of the psychometric properties of the measures. Clinical application and burden of administration will be addressed with specific recommendations for clinical practice. Participants will be given resources for obtaining free or low cost assessments of unilateral neglect.

Baily, M. J., Riddoch, M. J., & Crome, P. (2004). Test-retest stability of three tests for unilateral visual

neglect in patients with stroke: star cancellation, line bisection, and the baking tray task.

Neuropsychological Rehabilitation 14(4), 403-419. doi: 10.1080/0960201034000282

Bickerton, W. L., Samson, D., Williamson, J., & Humphreys, G. W. (2011). Separating forms of neglect

using the apples test: Validation and functional prediction in chronic and acute stroke. Neuropsychology, 25(5), 567-580. doi:10.1037/a0023501; 10.1037/a0023501

Buxbaum, L. J., Dawson, A. M., & Linsley, D. (2012). Reliability and validity of the virtual reality

lateralized attention test in assessing hemispatial neglect in right-hemisphere stroke. Neuropsychology, 26(4), 430-441. doi:10.1037/a0028674; 10.1037/a0028674

Hamilton, R. H., Coslett, H. B., Buxbaum, L. J., Whyte, J., & Ferraro, M. K. (2008). Inconsistency of

performance on neglect subtype tests following acute right hemisphere stroke. Journal of the International Neuropsychological Society: JINS, 14(1), 23-32. doi:10.1017/S1355617708080

Xxxxx is an occupational therapy with over 12 years of clinical experience working with adults with neurologic injury. Xxxxx primary role is working with students in a post professional OTD program to enhance their skills and knowledge in the treatment of clients with neurologic impairments. Xxxxx continues to provide occupational therapy services to adults with neurologic impairments.

This presentation will review available assessments of neglect with recommendations for practice based on the psychometric properties and clinical utility. Participants will be given resources for obtaining free or low cost assessments of unilateral neglect.

2015-804Decreasing Phantom Limb Pain in Upper Extremity Amputees

Rehab & DisabilityPostersIntermediate to topic

By viewing this poster and interacting with the presenter participants will be able to:

1. Describe the various treatments that address phantom limb pain in upper extremity amputees.

2. Describe and discuss the current and relevant literature regarding which intervention would better suit an individual’s lifestyle, both physically and mentally.

3. Identify the pros and cons of integrating these interventions into current clinical practice and justify the use of each treatment approach in both the clinic and home settings.

This poster is designed to provide occupational therapists and certified occupational therapy assistants with an overview of evidence-based research and treatment approaches needed to properly answer the following question: For clients living with an upper extremity amputation experiencing phantom limb pain, is mirror therapy a more effective intervention than biofeedback or silver shrinker socks in decreasing pain? Completing the five steps of an evidence based practice review was essential in creating this poster. This includes a description of a practice scenario, development of a PICO question, systematic review of the current literature, the integration of findings, and recommendations for practice and future research. Phantom limb pain (PLP) can be described as an extremely painful sensation felt in the missing limb of an amputee, which can last anywhere from seconds to minutes to hours to days. Phantom Limb Pain affects a majority of amputees, negatively affecting daily occupations. This poster is based on recently published articles that report on results regarding mirror therapy, biofeedback, and silver shrinker socks and their effect on decreasing PLP in upper extremity amputees. The results from the research studies were inconclusive as to which treatment was most effective in decreasing PLP. However, all three interventions were reported to decrease pain. Therapists are encouraged to utilize a combination of clinical reasoning and client centered care to choose among the three approaches when working with a client who is living with an upper extremity amputation.

Bosmans, J. C., Geertzen, J. H. B., Post, W. J., van der Schans, C., P., & Dijkstra, P. U. (2010). Factors

associated with phantom limb pain: A 31â „2-year prospective study. Clinical Rehabilitation, 24, 444-53.

Belleggia, G. and Birbaumer, N. (2001). Treatment of phantom limb pain with combined EMG and

thermal biofeedback: A case report. Applied Psychophysiology and Biofeedback, 26, 141-146. Chan, B. L., Witt, R., Charrow, A. P., Magee, A., Howard, R., & Pasquina, P. F. (2007). Mirror therapy

for phantom limb pain. The New England Journal of Medicine, 357, 2206-2207.

Darnall, B. D. (2009). Self-delivered home-based mirror therapy for low limb phantom pain. Am J Phys

Med Rehabil, 88, 78-81. Gallagher, P., Allen, D., & MacLachlan, M. (2001). Phantom limb pain and residual limb pain following lower limb amputation: A descriptive analysis. Disability & Rehabilitation, 23, 522-530.

Gartha, I. V. (1976). What is biofeedback? Canadian Family Physician, 22, 105-106.

Harden, R. N., Houle, T. T., Green, S., Remble, T. A., Weinland, S. R., Colio, S., Lauzon, J., and Kuiken,

T. (2005). Biofeedback in the treatment of phantom limb pain: A time-series analysis. Applied Psychophysiology and Biofeedback, 30, 83-93.

MacLachlan, M., McDonald, D., and Waloch, J. (2004). Mirror treatment of lower limb phantom pain: A

case study. Disability and Rehabilitation, 26, 901-904.

McAvinue, L. P., & Robertson, I. H. (2011). Individual differences in response to phantom limb

movement therapy. Disability & Rehabilitation, 33, 2186-2195.

Ramachandran, V. S., & Rogers-Ramachandran, D. (1996). Synesthesia in phantom limbs induced with

mirrors. Proceedings: Biological Sciences, 263, 377-386.

Richards, K., Baumann, I., Ranganathan, V., and Riordan, T. (n.d.). A randomized controlled crossover

study examining the therapeutic benefits between regular and silver shrinkers. Cleveland Clinic. Sinha, R. & Van Den Heuvel, W. J. A. (2011). A systematic literature review of quality of life in lower

limb amputees. Disability & Rehabilitation, 33, 883-899.

The primary presenter is currently a graduate student in the department of occupational therapy atXxxxx. The content for this poster was developed as a requirement in a full semester course on evidence based research. The faculty mentor for this project is a recognized expert in the evidence based process. The primary speaker has presented this content in a public forum prior to the proposal submission.

2015-805Upper Limb Amputations’ Prosthetic and Rehabilitation Solutions

Rehab & Disability50 minute sessionsIntermediate to topic

1. Understand and articulate the unique medical, rehabilitation, and prosthetic challenges of upper limb amputations.

2. Understand and articulate prosthetic options, based on patient’s functional needs, for all upper limb levels.

3. Understand evaluation and treatment considerations through all phases of intervention and prosthetic training.

4. Describe current and future technology, allowing for more intuitive control and functionality of current prosthetic devices.

Partial hand amputations comprise approximately 90% of all upper limb amputations (Dillingham, 2002). Presentation varies widely--the level of loss may involve a portion of one digit, multiple digits and/or portions of the metacarpal and carpal structures. Amputation surgery is primarily aimed at preserving as much length as possible, combined with restoring function to the greatest degree (Smith, 2007). Along with addressing the patient’s functional goals, it is imperative that the treating therapist address psychosocial and pain challenges that the patient may be experiencing. Levels of self-perceived disability are frequently greater in patients with partial hand amputations than those with unilateral transradial and transhumeral amputations (Phillips, 2012). Given recent advances that provide improved fit and more robust body powered and electric prosthetic componentry, patients have a broader range of options than in the past (Zlotolow & Kozin, 2012). Occupational therapists, in partnership with prosthetists, hand surgeons and other team members, help to guide optimal prosthetic choices for the patient based on client strengths, needs and the demands of their environment. Prosthetics that do not meet the patient’s specific requirements are contraindicated (Macklin, 2002) and will not be worn by the patient. Working with an upper limb prosthetic specialist ensures that the patient has access to the widest array of appropriate prosthetic options to meet his or her individual functional requirements Prosthetic intervention is critical to help reduce the risk of overuse injuries of the unaffected hand and to restore a more natural grasp. In addition to specialized prosthetic intervention, occupational therapists provide education and work with patients to create adaptive solutions. Current and future prosthetic options for all levels including therapeutic strategies will be explored. Examples of all options will be demonstrated to highlight the overall benefit of prosthetic rehabilitation to help restore functional independence.

Dillingham, et al. Limb Deficiency and Amputation Epidemiology and Recent Trends in the US.

Southern Medical Journal, 2002; 95:875-83.

Macklin E, et al, Rehabilitation of the Hand and Upper Extremity, 5th Ed, 2002, p.1467.

Phillips, et al. Experiences and Outcomes With Powered Partial Hand Prostheses: A Case Series of

Subjects With Multiple Limb Amputations. Journal of Prosthetics and Orthotics, 2012 Vol.24 (2), 93-97.

Smith, Douglas “Partial-Hand Amputations.” inMotion January/February 2007;17(1):56-61.

Zlotolow, DA & Kozin, SH. Advances in Upper Extremity Prosthetics. Hand Clin, 2012 Nov 28(4):

587-93.

Xxxxx., MOT, OTR/L, Occupational Therapist, Xxxxx Rehabilitation Coordinator. Xxxxx joined Xxxxx in April 2013, as a rehabilitation coordinator at the Xxxxx in Philadelphia, Pennsylvania. Xxxxx has presented at the Xxxxx’a MEC Symposium along with presentations on partial hand prosthetic solutions at ASHT and AOTA in 2014. Xxxxx has also presented a course titled: “Upper Limb Loss Prosthetic Rehabilitation: An Introductory Course” during a xxxxxxxxx meeting in November, 2014. Xxxxx has provided many in-services for local hospitals, rehab centers and universities alongside upper limb prosthetic specialist Xxxxx, CP. Xxxxx is certified by the National Board for Certification in Occupational Therapy and is also a certified lymphedema therapist.