Evidence-based rehabilitation and secondary prevention interventions improve poststroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where postacute care (PAC) is delivered. The American Heart Association developed quality standards based on the American Heart Association 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. American Heart Association staff and PAC sites in Montana convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in Montana and quantitative results from the nationwide survey and Montana sites were analyzed and used to refine the standards further. The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding Montana findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure that performance improvement initiatives are followed. However, with adequate support and resources, most Montana sites stated that they would be able to meet the proposed standards. We conclude that the Stroke PAC Quality Standards are applicable in PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.

Abstract Introduction Parkinson’s disease (PD) ranks second among progressive chronic neurodegenerative diseases, with high prevalence and annual incidence. Therefore, it is necessary to update the current and developing occupational therapy options for this pathology. Objective To map the practices and approaches of occupational therapists conducted through therapeutic interventions in PD. Method Review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist, based on the methodology of the Joanna Briggs Institute. The research question was formulated using the PCC (Patient, Concept, and Context) acronym, with primary and secondary terms consulted in the DeCS/MeSH multilingual thesaurus. Searches were conducted on five scientific databases between 2011 and 2020. Blind researchers were compared by the degree of agreement measured by Cohen’s kappa coefficient. Results The findings indicate that there are at least eight categories of practices and approaches performed by occupational therapists in PD. Most procedures are conducted at home. Research in outpatient environments is the primary setting for knowledge production in the field. Strategies focused on physical and functional behaviors are most in demand in PD, with measurable results, while occupation-based interventions show modest results. Conclusion The actions of occupational therapists in PD are highly variable, occur in different contexts, and their outcomes suggest that not all mapped options present consistent results or are not sufficiently detailed to favor a better interpretation of the findings.

Resumo Introdução A doença de Parkinson (DP) é a segunda no grupo das doenças neurodegenerativas crônicas progressivas, com alta prevalência e incidência anual. Portanto, faz-se necessário atualizar as opções terapêutico-ocupacionais, vigentes ou em desenvolvimento, para essa patologia. Objetivo Mapear as práticas e abordagens de terapeutas ocupacionais conduzidas por meio de intervenções terapêuticas na DP. Método Revisão conduzida em atenção ao “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist”, baseada na metodologia do Joanna Briggs Institute. A pergunta de pesquisa foi elaborada a partir do acrônimo PCC (Paciente, Conceito e Contexto), cujos termos principais e secundários foram consultados no DeCS/MeSH. As buscas foram realizadas em cinco plataformas científicas entre 2011 e 2020. Os pesquisadores cegos foram comparados pelo grau de concordância aferido pelo coeficiente kappa de Cohen. Resultados Os achados indicam que há pelo menos oito categorias de práticas e abordagens realizadas por terapeutas ocupacionais na DP. A maioria dos procedimentos é executado no domicílio. A pesquisa em ambiente ambulatorial é o grande cenário de produção de conhecimento na área. As estratégias focadas em condutas físicas e funcionais são as mais demandadas na DP, com resultados aferíveis, ao passo que as intervenções baseadas em ocupações manifestam resultados discretos. Conclusão As atuações do terapeuta ocupacional na DP têm ampla variabilidade, ocorrem em diferentes contextos e seus desfechos sugerem que nem todas as opções mapeadas apresentam resultados consistentes ou não são suficientemente detalhadas para favorecer uma melhor interpretação dos achados.

Introduction: Evidence-based rehabilitation and secondary prevention interventions improve post-stroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where post-acute care (PAC) is delivered. Purpose: The American Heart Association (AHA) developed quality standards based on the AHA 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. Methods: An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. AHA staff and PAC sites in Montana (MT) convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in MT, and quantitative results from the nationwide survey and MT sites were analyzed and used to refine the standards further. Results: The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding MT findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure performance improvement initiatives are followed. However, with adequate support and resources, most MT sites stated they would be able to meet the proposed standards. Conclusions: The Stroke PAC Program Standards are applicable in diverse PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.

Rehabilitation, seen as a disability-specific service needed only by few of the world's population, has not been prioritized in countries and is under-resourced. A rehabilitation-ready health workforce is potentially the most important resource for improving functioning and the quality of life for the 2.41 billion people worldwide needing this care. In April 2019, CGFNS International, Inc., and the Association of Schools Advancing Health Professions (ASAHP) partnered to respond to the World Health Organization's Rehab 2030, which emphasizes the need for global action by professional organizations, development agencies, and civil society to develop and maintain a sustainable workforce for rehabilitation under different healthcare models in different economies. The global certification framework presented in this article provides a mechanism to validate rehabilitation knowledge and practice competence of individual health workers. The impact of certification on upgrading rehabilitation education and upskilling the world's rehabilitation health workforce cannot be overstated.

To meet the needs of the 2.41 billion people seeking rehabilitation care, the world’s health workforce must be sustainable and scalable. In 2021, the WHO launched its Rehabilitation Competency Framework (RCF) to help countries build local rehabilitation ecosystems by focusing on high-level priorities. A top priority is the development of a health workforce that is sustainable and scalable to meet local needs. To capitalize on existing health workforce resources, countries need to focus on the specialists and on other members of the rehabilitation team who can assume targeted responsibilities for delivering care. To support these efforts, CGFNS International, Inc., an assessment organization for health professionals worldwide, is developing two exam-based global certifications, one for rehabilitation health workers and one for registered nurses working in rehabilitation settings. These global certifications assess the knowledge and competencies of individual rehabilitation health workers and nurses and certify those who meet the standards. For consumers, global certification attests to the competence of local service providers and helps ensure quality care. For health workers and nurses, global certification confers a credential that recognizes their expertise and supports their continuing professional development and career goals. And for policymakers, global certification provides useful information for managing care delivery. This article provides the rationale behind global certification, describes the methodology for creating these certifications, and shows how their underlying constructs and those of the WHO’s RCF align. This alignment helps consumers, health workers and nurses, and local authorities use all available tools to make informed decisions advancing rehabilitation care.

This study aimed to examine the occupational lives of persons served in the Basic Health Unit or employed in the National Institute of Social Security within communities in Belem, Brazil. A mixed-method design was performed with qualitative interviews and two quantitative measurements, the Canadian Occupational Performance Measure, and the Health Assessment Questionnaire. The intent was to provide occupational therapists a better understanding of the need for their service in both institutions. The two populations included were similar regarding age, gender, and race, however, although connected geopolitically, differences in educational level, income, and access to goods and services were noted. The results demonstrated that both groups experienced difficulties and unfulfilled wishes for their occupational performances and lack of occupational engagement, due to environmental circumstances, which may lead to a risk of occupational injustice. This study contributes valuable knowledge which may determine if occupational therapy services could benefit these populations.

Hope is needed for human action and social transformation. To promote and empower community participation is a key process in a time that neoliberal economy promotes social atomism and individualization. For doing so, critical and epistemic reflexivity is needed in contexts of occupational apartheid. A reflexive analysis of current issues and potential futures of occupational therapy within an intentional dialogue. ResumoA esperança é necessária para a ação humana e a transformação social. Promover e capacitar a participação da comunidade é um processo essencial em um momento em que a economia neoliberal promove o atomismo social e a individualização. Para isso, é necessária uma reflexividade crítica e epistêmica em contextos de apartheid ocupacional. Uma análise reflexiva das questões atuais e futuros potenciais da terapia ocupacional dentro de um diálogo intencional.Palavras-chave: Reflexividade crítica, engajamento colaborativo, incapacidade ocupacional, ocupação transformacional. ResumenSe necesita esperanza para la acción humana y la transformación social. Promover y potenciar la participación comunitaria es un proceso clave en un momento en que la economía neoliberal promueve el atomismo social y la individualización. Para hacerlo, se necesita reflexividad crítica y epistémica en contextos de apartheid ocupacional. Un análisis reflexivo de los problemas actuales y los futuros potenciales de la terapia ocupacional dentro de un diálogo intencional.Palabras clave: Reflexividad crítica, compromiso colaborativo, discapacidad laboral, ocupació transformadora.

Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.

Nearly half of all strokes are considered mild strokes. 1 Wolf T.J. Baum C. Conner L.T. Changing face of stroke: implications for occupational therapy practice. Am J Occup Ther. 2009; 63: 621-625 Crossref PubMed Scopus (107) Google Scholar Even though people with mild stroke may have minimal or no difficulty with everyday tasks like getting dressed or following a morning routine, they may have greater difficulty with more complex everyday activities like returning to work. 2 Hu X. Heyn P.C. Schwartz J. Roberts P. Johnston M. Gilbody S. What is mild stroke?. Arch Phys Med Rehabil. 2017; 15: 233-240 Google Scholar Although mild stroke affects each person differently, many people report some changes in their ability to: •move arms and hands quickly and with good coordination •move legs and feet quickly and with good coordination •think quickly and clearly 3 Hartke R.J. Trierweiler R. Survey of survivors’ perspective on return to work after stroke. Top Stroke Rehabil. 2015; 22: 326-334 Crossref PubMed Scopus (21) Google Scholar , 4 Kauranen T. Turunen K. Laari S. Mustanoja S. Baumann P. Poutiainen E. The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke. J Neurol Neurosurg Psychiatry. 2013; 84: 316-321 Crossref PubMed Scopus (56) Google Scholar , 5 Moran G.M. Fletcher B. Feltham M.G. Calvert M. Sackley C. Marshall T. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol. 2014; 21: 1258-1267 Crossref PubMed Scopus (106) Google Scholar •see clearly •speak and/or understand information •maintain physical and mental energy and stamina 6 Hartke R.J. Trierweiler R. Bode R. Critical factors related to return to work after stroke: a qualitative study. Top Stroke Rehabil. 2011; 18: 341-351 Crossref PubMed Scopus (47) Google Scholar •manage emotions 3 Hartke R.J. Trierweiler R. Survey of survivors’ perspective on return to work after stroke. Top Stroke Rehabil. 2015; 22: 326-334 Crossref PubMed Scopus (21) Google Scholar , 5 Moran G.M. Fletcher B. Feltham M.G. Calvert M. Sackley C. Marshall T. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol. 2014; 21: 1258-1267 Crossref PubMed Scopus (106) Google Scholar

Adults with mild stroke face substantial challenges resuming valued roles in the community. The term “mild” provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.

The purpose of this study was to investigate the effectiveness of an intentional blending of instructional strategies in an occupational therapy (OT) entry-level master’s course. The OT Adult Practice course uses case-based instructional strategies, clinical skills labs, and standardized patient experiences in a dovetailed approach across three progressively complex clinical scenarios involving adult clients. The course is designed to support students in addressing the entire OT Process. Results of quantitative data analysis indicated that the sequential application of case-based instructional strategies, lab experiences, and standardized patient learning opportunities significantly improved students’ self-perception of their level of comfort and skill in being able to perform the following components of the OT process for adult clients: occupational profile, OT evaluation, developing an OT treatment plan, implementing OT treatment, and planning for discharge.

The purpose of this study was to investigate the effectiveness of an intentional blending of instructional strategies in an occupational therapy (OT) entry-level master’s course. The OT Adult Practice course uses case-based instructional strategies, clinical skills labs, and standardized patient experiences in a dovetailed approach across three progressively complex clinical scenarios involving adult clients. The course is designed to support students in addressing the entire OT Process. Results of quantitative data analysis indicated that the sequential application of case-based instructional strategies, lab experiences, and standardized patient learning opportunities significantly improved students’ self-perception of their level of comfort and skill in being able to perform the following components of the OT process for adult clients: occupational profile, OT evaluation, developing an OT treatment plan, implementing OT treatment, and planning for discharge.

Background. Neurorehabilitation studies suggest that manipulation of error signals during practice can stimulate improvement in coordination after stroke. Objective. To test visual display and robotic technology that delivers augmented error signals during training, in participants with stroke. Methods. A total of 26 participants with chronic hemiparesis were trained with haptic (via robot-rendered forces) and graphic (via a virtual environment) distortions to amplify upper-extremity (UE) tracking error. In a randomized crossover design, the intervention was compared with an equivalent amount of practice without error augmentation (EA). Interventions involved three 45-minute sessions per week for 2 weeks, then 1 week of no treatment, and then 2 additional weeks of the alternate treatment. A therapist provided a visual cursor using a tracking device, and participants were instructed to match it with their hand. Haptic and visual EA was used with blinding of participant, therapist, technician-operator, and evaluator. Clinical measures of impairment were obtained at the beginning and end of each 2-week treatment phase as well as at 1 week and at 45 days after the last treatment. Results. Outcomes showed a small, but significant benefit to EA training over simple repetitive practice, with a mean 2-week improvement in Fugl-Meyer UE motor score of 2.08 and Wolf Motor Function Test of timed tasks of 1.48 s. Conclusions. This interactive technology may improve UE motor recovery of stroke-related hemiparesis.

Background The incidence of type II diabetes mellitus (DMT2) is expected to continue to rise. Current research has analyzed various tools, strategies, programs, barriers, and support in regards to the self-management of this condition. However, past researchers have yet to analyze the education process; including the adaptation of specific strategies in activities of daily living and roles, as well as the influence of health care providers in the integration of these strategies. Objectives The purpose of this qualitative case study was to identify the strengths and limitations of the current model of diabetes education in the United States and hypothesize how technology can impact quality of life. Methods Key informants on diabetes education were recruited from diabetes education centers through the American Association of Diabetes Educators. Semi-structured interviews were conducted with participants. Results Health care practitioners convey limited knowledge of DMT2. Individuals with DMT2 often have limited understanding of the implications of poor self-management. There appears to be no consistent standard of care for how to effectively incorporate self-management strategies. There is limited education for the use of technology in self-management. Diabetes educators describe that technology could be beneficial. Conclusion Findings suggest the importance of the role of care providers in emphasizing the implications of poor self-management strategies; that a multidisciplinary approach may enhance the education process; and a need for further developments in technology to address DMT2 self-management strategies.

BACKGROUND:Neurorehabilitation studies suggest that manipulation of error signals during practice can stimulate improvement in coordination after stroke.OBJECTIVE:To test visual display and robotic technology that delivers augmented error signals during training, in participants with stroke.METHODS:A total of 26 participants with chronic hemiparesis were trained with haptic (via robot-rendered forces) and graphic (via a virtual environment) distortions to amplify upper-extremity (UE) tracking error. In a randomized crossover design, the intervention was compared with an equivalent amount of practice without error augmentation (EA). Interventions involved three 45-minute sessions per week for 2 weeks, then 1 week of no treatment, and then 2 additional weeks of the alternate treatment. A therapist provided a visual cursor using a tracking device, and participants were instructed to match it with their hand. Haptic and visual EA was used with blinding of participant, therapist, technician-operator, and evaluator. Clinical measures of impairment were obtained at the beginning and end of each 2-week treatment phase as well as at 1 week and at 45 days after the last treatment.RESULTS:Outcomes showed a small, but significant benefit to EA training over simple repetitive practice, with a mean 2-week improvement in Fugl-Meyer UE motor score of 2.08 and Wolf Motor Function Test of timed tasks of 1.48 s.CONCLUSIONS:This interactive technology may improve UE motor recovery of stroke-related hemiparesis.

This paper examined the effect of a unique amalgam of adult learning methodologies near the end of the occupational therapy (OT) students' didactic education as a means to enhance readiness for clinical practice.Results of quantitative and qualitative data analysis indicated that the use of standardized patients, in combination with a sequential, semistructured, and progressively challenging series of client cases, in an OT adult practice (intervention) course, improved the students' self-perception of their level of comfort and skill on various foundational, yet essential, OT-related competencies.