American Journal of Occupational Therapy最新文献

{"title":"Occupational Participation and Physical Activity Among Adults Who Recovered From COVID-19 and Those Who Did Not.","authors":"Yeasir A Alve, Renée R Taylor","doi":"10.5014/ajot.2025.051161","DOIUrl":"10.5014/ajot.2025.051161","url":null,"abstract":"<p><strong>Background: </strong>Although substantial evidence exists regarding persistent symptoms and functional impairment in hospital settings following COVID-19, there is a noticeable lack of data on occupational participation and physical activity in community-based settings.</p><p><strong>Objective: </strong>To compare the levels of occupational participation and physical activity among adults who had recovered from acute COVID-19 infection and those who had not recovered.</p><p><strong>Design: </strong>Retrospective comparative cohort descriptive study.</p><p><strong>Participants: </strong>Fifty English-speaking adults age 18 yr or older who tested positive for COVID-19 within the past 4 yr but not within the past 6 mo were enrolled, including participants who had not recovered and those who had fully recovered.</p><p><strong>Outcomes and measures: </strong>Measures included the Occupational Self-Assessment-Short Form and Modifiable Activity Questionnaire. Chi-square tests and independent-samples t tests were used for data analysis.</p><p><strong>Results: </strong>Individuals who did not fully recover from COVID-19 displayed significant differences in age (p = .002), marital status (p = .026), body mass index (p = .003), and disability income (p = .034) compared with those who recovered. They also reported lower competence (p = .049) in occupational participation and spent less time (p < .001) and effort (p < .001) on occupational activities.</p><p><strong>Conclusions and relevance: </strong>The results confirm the Model of Human Occupation theory that physical limitations can impede a person's daily activities and restrict their participation in more strenuous tasks. Nonetheless, this does not diminish the value of occupational participation, even if they are presently engaged in lighter indoor leisure activities. Plain-Language Summary: The Model of Human Occupation theory highlights that occupational participation-how individuals engage in work, play, and daily activities within their social and cultural environments-is vital for well-being. After COVID-19, many people continue to face lingering symptoms, yet understanding of its effects on occupational participation and physical activity in community settings is limited. This study compared occupational participation and physical activity levels between adults fully recovered from acute COVID-19 and those still recovering. The results showed clear differences, with those not fully recovered feeling less competent in managing daily tasks and participating less in physically or mentally demanding activities. These findings suggest that rehabilitation programs should focus not only on improving physical abilities but also on addressing the psychological factors involved in returning to daily life.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Describing the Dose of Outpatient Occupational Therapy Services for Children With Myelomeningocele.","authors":"Elizabeth Mance, Kristen Martin, Kelly Tanner","doi":"10.5014/ajot.2025.051123","DOIUrl":"https://doi.org/10.5014/ajot.2025.051123","url":null,"abstract":"<p><strong>Importance: </strong>Occupational therapy can help children with myelomeningocele (CWM) maximize their independence. However, the current dose of usual-care occupational therapy services provided is unknown. Defining the dose of occupational therapy services will lay the groundwork for future intervention studies by providing a starting point for the development of intervention protocols.</p><p><strong>Objective: </strong>To investigate the demographics and dosage (frequency, intensity, time, and type) of occupational therapy sessions for CWM and describe the usual-care outpatient hospital-based occupational therapy dosage at one institution.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Large urban-suburban pediatric hospital with eight outpatient clinics.</p><p><strong>Participants: </strong>Twenty CWM, ages 0 to 18 yr (median = 4.85, interquartile range [IQR] = 3.75), receiving services from December 2021 through November 2023.</p><p><strong>Intervention: </strong>Usual care.</p><p><strong>Outcomes and measures: </strong>Occupational therapy dose included frequency (total number of therapy sessions), intensity (Child Effort Rating Scale [CERS] scores), time (timed billing charges), and type (interventions and services).</p><p><strong>Results: </strong>Participants received 258 total occupational therapy treatment sessions during the study period. Median frequency of sessions was 5.0 (IQR = 9.75). The mean CERS score was 3.01 (SD = 0.27), indicating average effort toward goals. Each therapy appointment averaged 51.87 min (SD = 7.82). Neuromuscular and musculoskeletal approaches were the most frequently used intervention type for general visits.</p><p><strong>Conclusions and relevance: </strong>Participants' outpatient occupational therapy dosage at one pediatric hospital varied. This population has no dosage guidelines, and this article represents a step forward for the field by thoroughly describing the dose of usual-care therapy provided over 2 yr. Plain-Language Summary: Occupational therapy can help children with myelomeningocele (CWM) maximize their independence. However, the current dose of usual-care occupational therapy services that are provided is unknown. This study describes the outpatient occupational therapy dose for CWM at a large hospital with multiple clinic sites. The information gathered from this study can assist occupational therapy practitioners in understanding common intervention strategies for CWM. The study results also lay the groundwork for future intervention studies by providing a starting point for the development of intervention protocols.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Metacognitive Strategy Intervention for People With Parkinson's Disease: Pilot and Feasibility Trial.","authors":"Erin R Foster, Tasha Doty, Meghan C Campbell, Ken Schechtman, Joan Toglia","doi":"10.5014/ajot.2025.051200","DOIUrl":"10.5014/ajot.2025.051200","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Cognitive impairment is a common and disabling feature of Parkinson's disease (PD), and interventions to mitigate its negative functional consequences are in high demand. Metacognitive strategy interventions, such as the Multicontext (MC) Approach, may support daily function among people with PD (PwPD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine feasibility, participant acceptance, and preliminary estimates of the MC Approach's treatment effect for PwPD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Quasi-randomized controlled pilot trial. Participants underwent pretreatment assessment, allocation to treatment group (MC, n = 29; control, n = 28), 10 treatment sessions, 1-wk posttreatment assessment, and 3-mo questionnaire follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Participants' homes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;PwPD without dementia but with subjective cognitive concerns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Ten weekly sessions of the MC Approach, which aimed to develop awareness and strategies to control cognitive performance across activities via therapist mediation, functional activity performance, and homework. The control intervention used the same structure and treatment activities but did not address awareness or strategy use or use mediated learning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes and measures: &lt;/strong&gt;Indicators of trial feasibility (recruitment, retention, study duration), participant acceptance (satisfaction, homework completion), and treatment effect (self-rated functional cognitive goal performance).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We enrolled 3 participants/mo and had 87% retention. Both groups' satisfaction and homework completion were high. Compared with control participants, MC participants reported greater improvement in functional cognitive goal performance from preintervention to postintervention that was maintained at follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;The MC Approach is a feasible, acceptable, and potentially efficacious intervention to address the functional cognitive goals of PwPD without dementia. A larger, fully randomized trial is required to provide definitive efficacy data. Plain-Language Summary: Cognitive impairment is one of the most common and disabling features of Parkinson's disease. As such, cognitive interventions that support daily function for this population are in high demand. The purpose of this study was to establish the feasibility of one such potential intervention, the Multicontext (MC) Approach, among people with Parkinson's disease (PwPD) without dementia. We also wanted to generate preliminary estimates of its effect on everyday cognitive function to inform future definitive trials. In a pilot quasi-randomized controlled trial, we found that the MC Approach is feasible, safe, and acceptable for people with PwPD. We also found that it may improve self-rated performance of daily cognitive goals. We can now proceed with a full-scale randomized controll","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Assessment in Occupational Therapy: A Qualitative Analysis.","authors":"Anna E Boone, Timothy S Marks, Timothy J Wolf, Gordon M Giles, Dorothy Farrar-Edwards","doi":"10.5014/ajot.2025.051112","DOIUrl":"10.5014/ajot.2025.051112","url":null,"abstract":"<p><strong>Importance: </strong>Standardized evidence-based cognitive assessments, including functional cognitive assessments, are key to the identification of cognitive impairments and provision of occupational therapy services.</p><p><strong>Objective: </strong>To explore the current practices related to cognitive assessments and barriers to their use in acute care and inpatient rehabilitation occupational therapy services.</p><p><strong>Design: </strong>We used a cross-sectional, qualitative approach that included five focus groups conducted with occupational therapy practitioners and key informant interviews with occupational therapy supervisors (n = 5). Data were analyzed by two coders using an inductive content analysis approach.</p><p><strong>Setting: </strong>Acute care and inpatient rehabilitation hospitals.</p><p><strong>Participants: </strong>Occupational therapy practitioners (N = 31).</p><p><strong>Results: </strong>Customary cognitive assessment included use of self- and proxy report measures, neurocognitive screening tools, and skilled observation. Use of standardized tests, including performance-based tests (PBTs), was limited. Barrier-related themes endorsed by most participants included organizational pressures, accessing and using evidence, conforming to the setting's culture, characteristics of the built environment, and assessment complexity. An outlier group that relied heavily on performance-based functional cognitive tests was identified.</p><p><strong>Conclusions and relevance: </strong>Current occupational therapy practice primarily consists of informal, unstandardized methods of identifying cognitive impairments. Use of standardized assessment is infrequent. Personal and organizational barriers identified were consistent with those identified in the literature. Despite endorsing identified barriers that are perceived as constraining their use, an outlier group consistently used PBTs of functional cognition. This outlier group's negotiation of barriers presents opportunities for how to target evidence-based implementation efforts. Plain-Language Summary: This article describes occupational therapists' current practices related to the use of cognitive tests. We asked therapists about factors that affect their use of different types of formal cognitive tests; specifically, we looked at the use of pencil-and-paper cognitive tests versus tests that use simulated real-world activities to assess function. Occupational therapists reported many barriers to using cognitive tests of either type, including a lack of time, difficulty accessing tests, and unfamiliar tests that are hard to learn. Most therapists predominantly use informal methods of assessing client's cognition or pencil-and-paper screening methods. One group differed in that its members mostly used formal assessments of simulated real-world tasks to evaluate the ability to perform everyday life tasks.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Lateral Elbow Pain on Pronation and Supination Torques and Influence of Forearm Rotation Angle.","authors":"Cristina Herrera-Ligero, Daniel Sánchez-Zuriaga, Úrsula Martínez-Iranzo, Helios De Rosario","doi":"10.5014/ajot.2025.051118","DOIUrl":"10.5014/ajot.2025.051118","url":null,"abstract":"<p><strong>Importance: </strong>Lateral elbow pain (LEP) is associated with damage to the accessory rotator muscles of the forearm, but there is little evidence of the effect of LEP on pronosupination torques and its influencing factors.</p><p><strong>Objective: </strong>To analyze the differences in forearm pronosupination torques between affected and sound limbs in patients with LEP and to investigate the influence of sex, age, dominance, and forearm position.</p><p><strong>Design: </strong>A cross-sectional study, using a stepwise selection algorithm for analysis of variance, to assess torque variations on the basis of the considered factors.</p><p><strong>Setting: </strong>Biomechanical analysis laboratory in a university research institute.</p><p><strong>Participants: </strong>A convenience sample of 36 people with LEP, predominantly middle-aged, with a majority presenting with dominant upper limb involvement.</p><p><strong>Outcomes and measures: </strong>Torque measurements for pronation and supination in multiple forearm positions.</p><p><strong>Results: </strong>Participants had significant deficits in pronosupination torques in affected limbs compared with sound limbs, particularly in extreme positions. The largest differences were observed in the supination direction with 60° of forearm pronation and the pronation direction with 60° of forearm supination. Sex and dominance significantly influenced torque production, but age did not.</p><p><strong>Conclusions and relevance: </strong>The greatest values and differences in torque between sound and affected limbs occurred for extreme rotations of the forearm opposite to the direction of the movement, with significant amplifications on torque reduction for the affected side, nondominant limb, and female patients. Those results can be used to define assessment methods and to design training and evaluation methods that address relevant strength deficits of patients affected by LEP. Plain-Language Summary: Understanding the torque profiles of pronation and supination in lateral elbow pain can provide insights into functional impairments and guide occupational therapy rehabilitation strategies as well as progressive reincorporation into certain activities of daily living and work-related manual tasks. Our findings highlight the importance of assessing forearm movement in rehabilitation settings and emphasize the need for targeted interventions that focus on pronosupination function in patients with lateral elbow pain.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Theories and Frameworks That Guide Occupational Therapy Practice With Black Populations: A Scoping Review.","authors":"Amanda Dos Santos Pereira, Khalilah Robinson Johnson, Lilian Magalhães","doi":"10.5014/ajot.2025.051068","DOIUrl":"https://doi.org/10.5014/ajot.2025.051068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Globally, the occupational therapy profession has neglected to address the anti-Black racism in its therapeutic services. Although discussions on ethnic/racial issues have grown in the field in recent years, few studies have investigated the theoretical and methodological frameworks that inform the practices of occupational therapy practitioners who work with Black populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe and analyze the theoretical and methodological frameworks available to occupational therapy practitioners who provide services to Black populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;MEDLINE, CINAHL, PsycINFO, LILACS, SCIELO, Web of Science, and Scopus were searched for articles published in English and Portuguese from 2013 to 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection and data collection: &lt;/strong&gt;Scoping review procedures as outlined by Arksey and O'Malley (2005) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) were used to identify articles that reflect theoretical and methodological frameworks that guide the practices of occupational therapy practitioners who work with Black populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Forty-eight articles met the inclusion criteria and were organized into four themes: humanities and social sciences: theories and frameworks; occupation-centered approaches; addressing systemic inequalities through collective occupations, intersectionality, and the incorporation of Black epistemologies into occupational therapy practices; and methodological approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Findings suggest that occupational therapy practitioners must adopt an antiracist approach with Black populations and be guided by counterhegemonic and decolonial frameworks. More studies are needed to investigate the effectiveness and limitations of frameworks that guide therapeutic practices with Black populations. Plain-Language Summary: This scoping review interrogates anti-Black racism in occupational therapy practice and the relevant frameworks available to occupational therapy practitioners working with Black populations around the world. The authors identify practice and research gaps that remain in the discourse and provide pathways for action that address the needs and demands of these populations from an antiracist lens. Positionality Statement: The authors are Black, cisgender, heterosexual, female-identifying occupational therapy practitioners and academic activists who engage in research and practice at the intersections of antiracism, gender, and ableism in occupational therapy and occupational science. The first and third authors live in different regions of Brazil and speak Portuguese. The first author is from a state in northeastern Brazil, which has the largest percentage of Black residents outside the African continent. The third author is from southeastern Brazil, a region with ","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difference-Making Conditions for the Successful Implementation of IDEAS: A Provider Stigma-Reduction Training for and by Occupational Therapy Practitioners.","authors":"Sally Wasmuth, Dawn Bravata, Edward Miech","doi":"10.5014/ajot.2025.051085","DOIUrl":"10.5014/ajot.2025.051085","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Identity Development Evolution and Sharing (IDEAS) is an evidence-supported occupational therapy intervention for reducing provider stigma to promote health care equity. Its effectiveness relies on successful implementation. It is therefore critical to identify and examine key difference-makers that facilitate or impede implementation success and effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine difference-making conditions for the successful implementation of IDEAS in occupational therapy settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Occupational therapy sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Internal facilitators, occupational therapy staff, and site managers or stakeholders at nine clinical sites (N = 58).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes and measures: &lt;/strong&gt;The data sources included interviews generated using the Consolidated Framework for Implementation Research, to assess key implementation constructs; three validated ratings scales (the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure); and the Acceptance and Action Questionnaire-Stigma, a valid and reliable measure of enacted stigma, to assess intervention effectiveness. Coincidence analysis was used to identify difference-makers directly linked to implementation success and effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two implementation-related factors were identified as key difference-makers: design quality and packaging and impact of external facilitation. Sites with successful IDEAS implementation had either a strong positive value for design quality and packaging or a lower positive value for design quality and packaging bundled together with a strong positive value for impact of external facilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In addition to identifying effective evidence-based interventions to improve clinical practice, occupational therapy practitioners and their clients also stand to gain through a careful consideration of how implementation factors influence the success of evidence-based practices in real-world settings. Plain-Language Summary: This study looks at how to successfully use a program called Identity Development Evolution and Sharing (IDEAS) in occupational therapy settings. IDEAS is a training that helps reduce bias and stigma among health care providers by sharing real stories from people who have experienced discrimination in health care. Bias in health care can lead to unfair treatment and poor outcomes for people receiving health care. Reducing this bias is essential for making health care more fair and inclusive. Occupational therapists want to support equity, but they need effective tools and strategies to do so. IDEAS is one such tool, but it only works well when certain conditions are present. The researchers studied how IDEAS was used in nine occupational therapy clinics across the United States. They looked at what helped or ","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Mirror Therapy Versus Cognitive Therapeutic Exercise on Upper Limb Functionality, Autonomy, and Poststroke Quality of Life: A Randomized Trial.","authors":"Jessica Fernández-Solana, Rodrigo Vélez-Santamaría, Adrián Moreno-Villanueva, Sergio Álvarez-Pardo, Jerónimo González-Bernal, Mirian Santamaría-Peláez, Josefa González-Santos","doi":"10.5014/ajot.2025.050834","DOIUrl":"10.5014/ajot.2025.050834","url":null,"abstract":"<p><strong>Importance: </strong>A combination of rehabilitation techniques may be useful to optimize individualized treatment and efficient resource utilization.</p><p><strong>Objective: </strong>To assess the effect of cognitive therapeutic exercise (CTE) and mirror therapy (MT) combined with task-oriented training (TOT) on upper limb functionality, fine and gross motor skills, use of the paretic arm, functional independence in activities of daily living (ADLs), and quality of life among people with subacute stroke.</p><p><strong>Design: </strong>Randomized trial, longitudinal, and multicenter study with one control group (CG) and two experimental groups (EGs) who were assessed before, after, and 3 mo posttreatment.</p><p><strong>Setting: </strong>University of Burgos and Burgos University Hospital, Burgos, Spain.</p><p><strong>Participants: </strong>One hundred twenty patients with subacute stroke and motor symptoms in the upper limb recruited through consecutive nonprobabilistic sampling and excluding those with tremor due to another neurological disease or cognitive impairment.</p><p><strong>Intervention: </strong>MT + TOT (EG1) and CTE + TOT (EG2) over 20 1-hr sessions. T3he CG received usual therapy (TOT) that simulated everyday situations.</p><p><strong>Outcomes and measures: </strong>The studied variables were evaluated with the Action Research Arm Test, Box and Block Test, Motor Activity Log, FIM™-Functional Assessment Measure, and Stroke-Specific Quality of Life Scale.</p><p><strong>Results: </strong>Statistically significant differences were found between the CG group and both EGs, with improvements in upper limb functionality, fine and gross motor skills, use of the paretic arm, functional independence in ADLs, and quality of life. No differences were found between EGs.</p><p><strong>Conclusions and relevance: </strong>Application of these combined interventions improved all variables studied. Plain-Language Summary: This study found that the use of cognitive therapeutic exercise and mirror therapy combined with task-oriented training may improve upper limb functionality, fine and gross motor skills, the use of the paretic arm, functional independence in activities of daily living, and quality of life among people with subacute stroke.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronotype Shifts and Cognitive Performance in Stroke Survivors: Exploring the Impact of Occupational Therapy Treatment Timing on Rehabilitation Outcomes.","authors":"Ayelet Hersch, Corinne Serfaty, Sigal Portnoy","doi":"10.5014/ajot.2025.051036","DOIUrl":"10.5014/ajot.2025.051036","url":null,"abstract":"<p><strong>Importance: </strong>Stroke survivors commonly report persistent sleep disruptions during rehabilitation and postrecovery. Despite little research that explores the impact of stroke on a patient's chronotype, no studies have explored the differences in cognitive performance between treatment timing fitted and nonfitted to the patient's chronotype.</p><p><strong>Objective: </strong>To characterize the sleep chronotype in patients in the subacute poststroke period, to explore cognitive task performance differences during fitted and nonfitted hours, and to examine the relationships between sleep quality and cognitive performance.</p><p><strong>Design: </strong>Cohort design.</p><p><strong>Setting: </strong>Health care institution.</p><p><strong>Participants: </strong>Twenty men and women (M  age = 60.2, SD = 8.6) post-first stroke.</p><p><strong>Outcomes and measures: </strong>The following measures were collected twice, during fitted and nonfitted chronotypic times: demographic surveys, the Munich Chronotype Questionnaire, the Montreal Cognitive Assessment (MoCA), the Rivermead Behavioral Memory Test, Second Edition (RBMT-2), a fatigue questionnaire, and of actigraphy for 4 to 5 days.</p><p><strong>Results: </strong>Stroke survivors exhibited an earlier sleep chronotype postinjury compared with preinjury. Enhanced memory (higher RBMT-2 scores) occurred during fitted hours. No significant differences emerged in executive functions, attention tasks, and MoCA scores between fitted and nonfitted hours. The Wake After Sleep Onset index correlated with the MoCA and RBMT-2 scores during fitted hours (MoCA: r = .53, p = .021; RBMT-2: r = .51, p = .027). Number of awakenings correlated with the MoCA letter task during nonfitted hours (r = .45; p = .044).</p><p><strong>Conclusions and relevance: </strong>Occupational therapy practitioners should be aware of the relationship between chronotype and cognitive performance, with a focus on the importance of personalized rehabilitation strategies in stroke care. Plain-Language Summary: The timing of cognitive assessments poststroke can influence their reliability, particularly when considering a patient's chronotype (sleep cycle). For instance, if a morning person is evaluated later in the day (nonfitted to their chronotype), the results may indicate greater cognitive decline compared with scores they might achieve in the morning. In our study, we assessed cognitive performance twice: once fitted to the patient's chronotype and once not. Our findings revealed that memory function significantly improved during evaluations conducted at personalized times. This suggests that occupational therapy practitioners who evaluate patients during nonoptimal times may prescribe a more extensive rehabilitation plan than necessary.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Survey of Occupational Therapy Practitioners' Evaluation of Cognition in Adults.","authors":"Anna E Boone, Timothy S Marks, Timothy J Wolf, Gordon M Giles, Dorothy Farrar-Edwards","doi":"10.5014/ajot.2025.051113","DOIUrl":"10.5014/ajot.2025.051113","url":null,"abstract":"<p><strong>Importance: </strong>Cognitive skills play a central role in a person's independent community functioning. As a profession, occupational therapy practitioners need to understand how cognitive evaluation is incorporated into the overall provision of occupational therapy services.</p><p><strong>Objective: </strong>To describe occupational therapy practitioners' current practice for evaluating cognitive function in adults across treatment settings.</p><p><strong>Design: </strong>A cross-sectional survey conducted from September 2022 to September 2023.</p><p><strong>Setting: </strong>Web-based survey distributed through online platforms, direct e-mail invitations, and in person through flyer distribution.</p><p><strong>Participants: </strong>Four hundred forty-six licensed occupational therapy practitioners with at least 6 mo of experience in adult treatment settings.</p><p><strong>Results: </strong>Most occupational therapy practitioners evaluate cognition using clinical judgment rather than neurocognitive screening measures, χ2(9) = 52.39, p < .001; or functional cognitive measures, χ2(9) = 77.49, p < .001. More occupational therapy practitioners evaluate cognition using neurocognitive screening measures rather than functional cognitive measures, χ2(9) = 68.63, p < .001. The Montreal Cognitive Assessment (25.6%) was the most used standardized neurocognitive measure, and the Allen Cognitive Level Screen (15.2%) was the most widely used standardized functional cognitive measure. Various factors (e.g., time required for use, cost, ongoing peer or administrative support) were perceived to affect the selection and use of measures.</p><p><strong>Conclusions and relevance: </strong>Occupational therapy practitioners primarily use unstandardized methods to evaluate cognition. When standardized measures are used, neurocognitive measures were used more frequently than functional cognitive measures. Occupational therapy practitioners report that comprehensive evaluation of cognition includes information derived from a variety of sources. Plain-Language Summary: In this study, we describe the current practices of occupational therapy practitioners for evaluating cognitive function in adults. We found that occupational therapy practitioners most often evaluate cognition using unstandardized methods. Standardized paper-and-pencil neurocognitive measures are used more often than functional cognitive measures that observe a person's ability to perform practical real-world tasks.</p>","PeriodicalId":48317,"journal":{"name":"American Journal of Occupational Therapy","volume":"79 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}