A Delphi Panel of People With Parkinson's Disease Regarding Responsibility: Toward a Preliminary Taxonomy.

IMPORTANCE: A sense of agency is associated with complex occupation-related responsibilities. A taxonomy can guide clinicians in enhancing responsibility in patients with Parkinson's disease (PwPD). OBJECTIVE: To (1) discover levels of responsibility in occupations for PwPD and (2) propose a taxonomy for occupations. DESIGN: A two-round Delphi study with PwPD and a one-round Delphi study with international experts. SETTING: Electronic survey. PARTICIPANTS: PwPD (N = 75) and international experts (N = 8). OUTCOMES AND MEASURES: PwPD expressed their levels of an inherent sense of responsibility for each occupation (1 = very low responsibility, 5 = very high responsibility). International experts rated their level of agreement (5 = strongly agree, 1 = strongly disagree) with each dimension of the taxonomy. A consensus was determined to have been reached if the interquartile range was ≤1 and 70% agreement in two adjacent categories was achieved. RESULTS: Thirty-three occupation categories were deemed as having very high to moderate responsibility for PwPD. Consequences of actions and the presence of others made up the two-dimensional responsibility taxonomy. Occupations have more challenging responsibility characteristics when they are performed with free choice, a level of high physical effort, alone, and with moral consequences. CONCLUSIONS AND RELEVANCE: This study yielded the first consensus among PwPD regarding responsibility in occupations as well as a classification system for charting the complexity of responsibility in occupations. The occupation list we have created can be beneficial to health care professionals when providing interventions or conducting outcome assessments. Plain-Language Summary: When planning interventions for patients with Parkinson's disease, it can be helpful for clinicians to be aware of patients' perspectives regarding their sense of responsibility to perform occupations. The use of a systematic sequence of challenging occupations with responsibility attributes ranging from less complex to more complex can help enhance patient occupational participation.

Comparing Telerehabilitation and In-Person Interventions in School-Based Occupational Therapy for Specific Learning Disorder A Randomized Controlled Trial.

Objective: This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population. Materials & Methods: The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests). Results: Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes. Conclusion: In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR's transformative role in enhancing the holistic well-being of children with SLDs.

Effects of an Occupation-Based Intervention on Hand and Upper Extremity Function, Daily Activities, and Quality of Life in People With Burn Injuries: A Randomized Controlled Trial.

IMPORTANCE: Occupational performance and function are affected in people with burn injuries to the hand and upper extremity; this can lead to the development of some disabilities and endanger quality of life. OBJECTIVE: To investigate the effects of occupation-based intervention on hand and upper extremity function, daily activities, and quality of life in people with burn injuries. DESIGN: Randomized controlled trial. SETTING: Specialized burn hospital in Iran. PARTICIPANTS: Patients (N = 20) with burn injuries to the hand and upper extremity. INTERVENTIONS: The control group received only traditional rehabilitation, and the intervention group received traditional rehabilitation and took part in the Cognitive Orientation to daily Occupational Performance (CO-OP) protocol (18 sessions, 45 min/day, for both groups). MEASURES: Assessments included the CO-OP; Michigan Hand Outcomes Questionnaire; Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire; Modified Barthel Index; World Health Organization Quality-of-Life Scale-Brief; a visual analogue scale; measurements with a goniometer and dynamometer; and the figure-of-eight method. These evaluations were conducted with both groups before the rehabilitation program commenced and at Wk 2, 6, and 14 (follow-up). RESULTS: The results showed that there were notable changes in all the study variables except edema in both groups. However, these changes (p [V] ≤ .05) were not statistically significant between the two groups. CONCLUSIONS AND RELEVANCE: According to the results, the occupation-based interventions are as effective as traditional therapeutic interventions for the improvement of hand and upper extremity function, ability to perform daily activities, and quality of life in people with burn injuries. What This Article Adds: The CO-OP protocol, as an occupation-based intervention, can improve hand performance, ability to perform daily activities, and quality of life in people with burn injuries, and thus it can be useful in rehabilitation clinics.

A comparison of the effects of occupation-based interventions with and without responsibility feedback and conventional interventions on participation in people with idiopathic Parkinson's disease: study protocol for a randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder with debilitating motor and non-motor symptoms which affect participation in meaningful occupations. Occupation-based interventions can improve participation in people with PD. Evidence for incorporating structured and intensive occupational therapy by considering the concept of responsibility is lacking for this population. This trial will compare the effects of occupation-based interventions with and without responsibility feedback and conventional interventions on participation in people with idiopathic PD. METHODS: A total of 45 people with PD, between 35 and 85 years old and Hoehn and Yahr stages between I to III, will be recruited from movement disorder centers for this three-armed study. Participants will be randomized into three groups (occupation-based interventions with responsibility feedback, occupation-based interventions without responsibility feedback, and conventional interventions). All participants will receive intervention for 24 sessions during a period of 12 weeks (2 sessions per week). The primary outcome measure will be participation satisfaction. Participation frequency and restriction, self-perceived performance, performance satisfaction, motivation, volition, sense of agency, responsibility, physical activity, community integration, activities of daily living (ADL), instrumental ADL, upper extremity function, balance, fatigue, and quality of life will be measured as secondary outcome measures. All outcomes will be measured at baseline, session 9, session 17, post-intervention (week 13), and follow-up (week 25). DISCUSSION: This home-based high-intensity, structured, client-centered, and occupation-based intervention will be conducted by utilizing the concept of responsibility. This proposed trial may result in enhanced participation that would benefit other motor and non-motor symptoms in people living with PD. Findings from this proposed study are expected to expand the knowledge of clinicians and help them in evidence-based decision-making processes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20140304016830N13. Registered on August 19, 2022.

Consensus on Feedback Statements That Create Responsibility Among People With Parkinson's Disease: A Delphi Study.

IMPORTANCE: Sense of agency is associated with a sense of responsibility, which is essential to performing goal-directed occupations. OBJECTIVE: To reach consensus on a set of extrinsic feedback statements that have the potential to create a sense of responsibility among patients with neurological disorders in the course of performing daily or social occupations. DESIGN: Anonymous Delphi study with two rounds with international experts and one round with Irani patients with Parkinson's disease (PD). SETTING: Electronic survey. PARTICIPANTS: One hundred experts and 73 patients with idiopathic PD. OUTCOMES AND MEASURES: Experts and patients anonymously rated (5 = strongly agree/very effective, 4 = agree/effective, 3 = neither agree nor disagree/uncertain, 2 = disagree/ineffective, 1 = strongly disagree/very ineffective) their level of agreement with each survey statement and the effectiveness of each statement in creating a sense of responsibility in the course of performing daily or social occupations. Consensus was set as an interquartile range of ≤1 and ≥70% agreement in two adjacent categories of a Likert scale. RESULTS: In the experts' first round, consensus was reached on the level of agreement and effectiveness of 18 statements. In the second round, final consensus was achieved on all statements. In the one patient round, patients reached consensus on all statements. Finally, 34 statements were rated as 4 or 5 in terms of agreement and effectiveness, based on the opinions of experts and patients. CONCLUSIONS AND RELEVANCE: This study has produced a collection of feedback statements that might be useful in occupation-based interventions. What This Article Adds: Extrinsic responsibility feedback delivered while administering occupation-based interventions may increase volition, motivation, and engagement.

Occupations to Enhance Responsibility Among Patients With Parkinson's Disease: An International Delphi Study.

IMPORTANCE: The ability to perform voluntary actions is disrupted in Parkinson's disease (PD). Voluntary activities play a critical role in generating sense of agency, which underpins the concept of responsibility for people's daily occupations and their outcomes. According to this concept, the dearth of research regarding the concept of responsibility in rehabilitation hampers practitioners in delivering evidence-based care. OBJECTIVE: To generate a list of occupations that enhance an inherent sense of responsibility among people with PD that is based on consensus among experts. DESIGN: An anonymous and iterative Delphi study with two rounds. SETTING: Electronic survey. PARTICIPANTS: One hundred sixteen experts participated in the first round of the study, and 95 participated in the second round. OUTCOMES AND MEASURES: Panelists rated the level of inherent responsibility in each occupation and the importance of types of patient-related information on a 5-point Likert scale. Consensus was defined as reaching an interquartile range of >1. RESULTS: In the first round, consensus was reached on 19 occupations and all 38 types of patient-related information. Also, an additional 15 occupations and 16 types of patient-related information were added to the lists. Consensus was reached for all occupations and patient-related information presented in the second round. CONCLUSIONS AND RELEVANCE: Our results indicate that 61 occupations were deemed to enhance a moderate to a very high inherent sense of responsibility among people with PD. In addition, a wide range of patient-related information is considered very important or important while these occupation-focused interventions are delivered. What This Article Adds: Subjective knowledge of one's actions and their consequences lies behind people's daily occupations. Considering this knowledge when administering occupation-focused interventions can be beneficial for individuals with PD.

Minimal and robust clinically important difference of three fatigue measures in chronic stroke survivors.

BACKGROUND: Fatigue assessment scale (FAS), fatigue subscale of the Profile of Mood States (POMS-F), and vitality subscale of the Short Form Health Survey (SF-36-VT) are among the first and most widely used adapted tools for assessing post-stroke fatigue. OBJECTIVE: To identify the minimal clinically important difference (MCID) and robust clinically important difference (RCID) of FAS, POMS-F, and SF-36-VT in stroke survivors. METHODS: Participants completed the FAS, POMS-F, and SF-36-VT before and after receiving 6-week intervention including graded activity training and pacing therapy. MCID was calculated using the distribution-based and anchor-based methods. Further, accuracy, sensitivity, and specificity of calculated values using the distribution-based method were used for determining RCID. RESULT: A total of 124 stroke survivors participated in this study. MCID for FAS, POMS-F, and SF-36-VT was found to be 4.86, 3.32, and -10.10 (using score change) and 3.5, 2.5, and -10.5 (using ROC analysis), respectively. Using the distribution-based method, the MCID value obtained for the FAS was in the range of 3.16 to 8.76, for the POMS-F was in the range of 1.49 to 5.63, and for the SF-36-VT was in the range of -15.43 to -5.58. ½SD for FAS, ½ SD and 1.96 SEM for POMS-F, and 1.96 SEM and SD for SF-36-VT showed the best discriminative ability to use as the RCID. CONCLUSIONS: The MCID and RCID were calculated for FAS, POMS-F, and SF-36-VT using different methods. The results can be used by researchers and clinicians for interpreting their findings in subjects similar to those who participated in this study.

Efficacy of Occupational Performance Coaching with and without Four Quadrant Model of Facilitated Learning for mothers of children with specific learning disorder: Study protocol for a randomized controlled trial.

Background: In addition to academic problems, children with a specific learning disability (SLD) encounter problems with participation in activities outside school. Purpose: To investigate the efficacy of Occupational Performance Coaching (OPC) with and without Four Quadrant Model of Facilitated Learning (4QM) in the mothers of children with SLD. Method: A single-blinded, parallel-group randomized clinical trial will be carried out. Mothers of children with SLD will constitute the participants and be allocated to experimental (OPC+4QM) and control (OPC alone) groups. Key issues: Children's occupational performance and satisfaction, participation in activities outside school, goals attainment, executive function, and academic achievement along with self-efficacy of mothers will be measured in baseline, post-intervention, and one-month follow-up stages. Implications: An OPC intervention protocol may improve children's participation in activities outside school and may help clarify whether 4QM promotes maternal empowerment and better results for children with SLD. Trial registration: Clinical Trials, IRCT20140416017301N9. (https://en.irct.ir/trial/55842).

Effects of Meaningful Action Observation Therapy on Occupational Performance, Upper Limb Function, and Corticospinal Excitability Poststroke: A Double-Blind Randomized Control Trial.

Introduction: Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes. Method: A randomized control trial was designed to compare between experimental (n = 13) and control groups (n = 14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects. Result: Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p ≤ 0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p = 0.03) and satisfaction (p = 0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p ≥ 0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p = 0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments. Conclusion: Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.

The effects of supervised and non-supervised upper limb virtual reality exercises on upper limb sensory-motor functions in patients with idiopathic Parkinson's disease.

BACKGROUND: Impairments of upper limb (UL) sensory-motor functions are common in Parkinson's disease (PD). Virtual reality exercises may improve sensory-motor functions in a safe environment and can be used in tele-rehabilitation. This study aimed to investigate the effects of supervised and non-supervised UL virtual reality exercises (ULVRE) on UL sensory-motor functions in patients with idiopathic PD. METHODS: In this clinical trial study, 45 patients with idiopathic PD (29 male) by mean ± SD age of 58.64 ± 8.69 years were randomly allocated to either the control group (conventional rehabilitation exercises), supervised ULVRE or non-supervised ULVRE. Interventions were 24 sessions, 3 sessions/week. Before/after of interventions and follow-up period all assessment was done. Hand Active Sensation Test and Wrist Position Sense Test were used for assessing UL sensory function. Gross and fine manual dexterity were assessed by Box-Block Test and Nine-Hole Peg Test, respectively. Grip and pinch strength were evaluated by a dynamometer and pinch gauge, respectively. RESULTS: The results showed significant improvement in discriminative sensory function (HAST-weight and HAST-total), wrist proprioception, gross manual dexterity and grip strength of both less and more affected hands as well as fine manual dexterity of the more affected hand in the three groups in patients with idiopathic PD (P < 0.05). CONCLUSION: The results of this study indicated that both supervised and non-supervised ULVRE using the Kinect device might potentially improve some aspects of UL sensory-motor functions in patients with PD. Therefore, ULVRE using the Kinect device can be used in tele-rehabilitation, especially in the current limitations induced by the COVID-19 pandemic, for improving UL functions in patients with PD.

Apathy exacerbates postural control impairments in stroke survivors: The potential effects of cognitive dual-task for improving postural control.

Apathy is a stressor and debilitating common condition for both stroke survivors and their caregivers. However, its effects on the postural control of these patients have not yet been investigated. Improved postural stability through withdrawing attention from postural control by concurrent cognitive task (i.e. dual-task condition) has been reported previously, but the effect of apathy, as a confounding factor, remains unknown. This study aimed to examine the effects of apathy and dual-task condition on postural control of chronic stroke survivors from biomechanical and neurophysiological perspectives. Twenty non-apathetic stroke survivors, 20 apathetic stroke survivors, and 20 sex-, age-, weight-, and height-matched healthy subjects were assessed using different postural sway measures and electromyography activity of ankle and hip muscles while quietly standing on rigid and foam surfaces under single-task, easy dual-task, and difficult dual-task conditions. The results showed postural instability and neuromuscular stiffening of stroke survivors, particularly apathetic stroke survivors, compared with healthy controls as evidenced by significantly greater postural sway measures and increased co-contraction of ankle muscles as well as hip muscles. Notably, concurrently performing a cognitive task significantly reduced postural instability and neuromuscular stiffening in chronic stroke survivors even in those with apathy. In conclusion, apathy exacerbates postural control impairments in chronic stroke survivors promoting an inefficient conscious mode of postural control. It is recommended that distracting the attention away from postural control by performing a concurrent cognitive task can be considered an effective strategy while designing interventions for improving postural control in apathetic stroke survivors.

Effect of Occupation Performance Coaching with Four-Quadrant Model of Facilitated Learning on Children with Specific Learning Disorder.

Background: Children with a specific learning disability (SLD) have deficits in everyday occupations along with executive function in addition to academic issues. Objective: The present study is aimed at investigating the effectiveness of Occupational Performance Coaching (OPC) and the Four-Quadrant Model of Facilitated Learning (4QM) interventions on the participation in occupational performance and executive function skills in children with SLD. Method: This study was a single-case experimental design (multiple baselines) in which six children with SLD were randomly assigned to three groups. In the baseline phase, three groups of children underwent repeated executive function assessments using the Stroop Color and Word Test (SCWT) and the Wisconsin Card Sorting Test (WCST) in the multiple baselines. In the intervention phase, all six mothers of children with SLD individually received OPC and 4QM interventions once a week for 14 sessions of 60 minutes and during this period, children were evaluated six more times for executive function skills according to SCWT and WCST. In addition, The Canadian Occupational Performance Measure (COPM) and Behavior Rating Inventory of Executive Function (BRIEF) at the beginning and the end of the baseline phase and the end of the intervention phase were completed by mothers of children with SLD. Results: More than 50% PND of the SCWT and WCST in the visual analysis graph's information along with significant changes in COPM scores and large effect size of BRIEF subscales (Cohen's d ≥ 0.8) in pre- and postintervention showed the effectiveness of OPC and 4QM on the participation in occupational performance and executive function skills in children with SLD. Conclusion: The results of the study support the effectiveness of OPC and 4QM interventions on children with SLD. However, research with more participants and experimental methods can provide further evidence.

Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities.

IMPORTANCE: The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life. OBJECTIVE: To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors. DESIGN: Cross-sectional. SETTING: Medical and rehabilitation centers. PARTICIPANTS: One hundred twenty-three people (75 men, 48 women) with chronic stroke. OUTCOMES AND MEASURES: Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z). RESULTS: The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score. CONCLUSIONS AND RELEVANCE: The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.

The investigation of the effects of occupation-based intervention on anxiety, depression, and sleep quality of subjects with hand and upper extremity burns: A randomized clinical trial.

AIM: This study aimed to investigate the effects of occupation-based intervention on psychological factors and sleep quality of subjects with hand and upper extremity burns. METHODS: In this randomized controlled intervention trial, a total of 20 patients were randomly assigned to one of the control group or intervention group. The control group only received traditional rehabilitation. However, the intervention group received traditional rehabilitation and Cognitive Orientation to daily Occupational Performance (CO-OP), respectively (during 18 sessions, 45 min/day in both groups). Occupational therapy sessions were held three times a week for a six-week duration. Occupational performance and satisfaction, anxiety, depression, and sleep quality were measured before the intervention and in weeks 2, 6, and 14 (follow-up) using Canadian Occupational Performance Measure, Beck Anxiety Inventory, Self-rating Depression Scale, and Pittsburgh Sleep Quality Index, respectively. FINDINGS: The results of the present study show that there were significant changes in all the studied variables in the two groups. However, these changes (P ≤ 0.05) were not statistically significant between these two groups. CONCLUSION: The results of this study show that occupation-based interventions are as effective as traditional therapeutic interventions on improving the anxiety, depression, and sleep quality in patients with hand burn injuries.

Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases.

Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.

Validation and diagnostic accuracy of coin rotation task for manual dexterity and coordination in children with specific learning disorder.

BACKGROUND: This study aimed at determining validity, reliability, and diagnostic accuracy of Coin Rotation Task (CRT) in assessing manual dexterity and coordination of children with specific learning disorder (SLD). METHODS: In this non-experimental cross-sectional study, 120 children (typically developing children = 60, children with SLD = 60, mean age ± SD =9.18 ± 0.55) were recruited. Test-retest reliability and construct validity of CRT were assessed. Multivariate regression analysis was performed on CRT scores by considering age and gender as covariates and children with SLD with mild dexterity impairment and severe dexterity impairment (SDI) as outcome variables. Receiver-operating characteristics (ROC) curve analysis was carried out to derive validity parameters. RESULTS: Test-retest reliability of the CRT scores in both subtests were excellent in children with SLD (ICC2,1: 0.93-0.95) and good to excellent in typically developing children (ICC2,1: 0.72-0.82). Acceptable construct validity of CRT was also found. The CRT cut-off points were 23 (sensitivity= 89.29%, specificity= 70.37%) and 28 (sensitivity= 80.33%, specificity= 86.36%) for discriminating children with SLD and SDI from typically developing children in dominant and non-dominant hand, respectively. CONCLUSIONS: The present study indicated good to excellent test-retest reliability, acceptable validity, and high diagnostic accuracy for diagnosing children with SLD based on their dexterity impairment level.Implications for RehabilitationThe Coin Rotation Task (CRT) was modified and validated for use in children.The CRT is a reliable and valid tool with high diagnostic accuracy.The CRT has a good ability for discriminating children with specific learning disorder with severe dexterity impairment form typically developing children.Treatment plans and research designs can be performed by using this valid, reliable, and easy to administer tool.

Psychometric properties of dexterity questionnaire-24 in Iranian chronic stroke survivors.

INTRODUCTION: Dexterity is one of the most critical upper extremity functions that may be impaired in chronic stroke survivors. This study aimed to investigate the psychometric properties of DextQ-24 in Iranian chronic stroke survivors. METHOD: A total of 123 people with chronic stroke were included in the study. Internal consistency and test-retest reliability were assessed through Cronbach's alpha and Interclass Correlation (ICC), respectively. Dimensionality was performed by Exploratory Factor Analysis. In addition, to assess the convergent validity of DextQ-24, Box and Block Test, Motor Activity Log Questionnaire, ABILHAND Questionnaire, and Purdue Pegboard Test were used. Discriminant validity of DextQ-24 was measured between different stages of recovery (Brunnstrom stage). Acceptability was calculated by ceiling and floor effect. RESULTS: Cronbach's alpha and ICC were 0.92 and 0.91, respectively. The 24 items of this questionnaire were classified into six components. Further, a moderate to strong correlation between the total score of DextQ-24 with other tools | r = 0.41-0.84 | was obtained. The results of discriminant validity approved the ability of the total score of DextQ-24 to separate different stages of recovery. The results also reported that this questionnaire did not have a significant ceiling and floor effect. CONCLUSION: The results of our study showed that the Persian DextQ-24 has high reliability and a good convergent and discriminant validity in people with chronic stroke for dexterity measurement as a PROM questionnaire.

Anxiety and cognitive load affect upper limb motor control in Parkinson's disease during medication phases.

Anxiety is among the most debilitating nonmotor symptoms of Parkinson's disease (PD). This study aimed to determine how PD patients with low and high levels of anxiety (LA-PD and HA-PD, respectively) compare with age- and sex-matched controls at the level of motor control of reach-to-grasp movements during single- and dual-task conditions with varying complexity. Reach-to-grasp movement kinematics were assessed in 20 LA-PD, 20 HA-PD, and 20 sex- and age-matched healthy controls under single- as well as easy and difficult dual-task conditions. Assessment of PD patients was performed during both the on- and off-drug phases. The results obtained during dual-task conditions reveal deficits in both reach and grasp components for all three groups (e.g., decreased peak velocity and delayed maximum hand opening). However, these deficits were significantly greater in the PD groups, especially in the HA-PD group. Although dopaminergic medication improved reach kinematics, it had no effect on grasp kinematics. The results of our study indicated that high levels of anxiety may enhance the inefficiency of upper limb motor control in PD patients, especially during high demanding cognitive conditions, and should, therefore, be considered in the assessment and planning of interventions for upper limb function in these patients.

Effectiveness of Self-Action Observation Therapy as a Novel Method on Paretic Upper Limb and Cortical Excitability Post-Stroke: A Single-Subject Study.

Background: Action Observation Therapy (AOT) is a top-down approach that has been recently introduced in the rehabilitation of neurological disorders mainly after stroke. The main goal of this study was to investigate the effects and feasibility of a new technique in AOT procedure (called self-AOT) following periods of no treatment and routine AOT intervention on upper limb motor function, occupational performance and neurophysiological changes in a stroke patient. Methods: A single-subject A-B-A-C design was used and a 58-year-old woman with a 3-year history of left hemiplegia poststroke participated in this study. In the baseline (A1, A2) phases, the patient received no treatment. In the first intervention (B phase), she received a 4-week AOT, and in the second intervention (C phase), a 4 week of Self-AOT was practiced. In all phases, upper limb motor recovery as a target outcome was evaluated on 4 occasions using the Fugl-Meyer assessment. Upper limb function, dexterity and spasticity were assessed using Action Research Arm Test, Box-Block Test and Modified Modified Ashworth Scale respectively. Occupational Performance/Satisfaction was assessed with Canadian Occupational Performance Measure and to assess neuroplasticity, Motor Evoked Potential was recorded by Transcranial Magnetic Stimulation. Visual analysis, slope, and percentage of non-overlapping data were used for assessing the changes between phases. Results: Percentage of non-overlapping data and slopes indicated that motor recovery had clinically relevant improvements after both interventions compared to baselines. Other outcomes also showed improvements except for spasticity of wrist/elbow flexors and Motor Evoked Potential of opponens indicis. Conclusion: Self-AOT may be as effective as other procedures of AOT for improving upper limb motor function, occupational performance/satisfaction, and cortical excitability post-stroke.

The Development and Validation of a Scale for the Activities of Daily Living in Iranian Children.

Introduction: Activities of Daily Living (ADL), as an ultimate goal of rehabilitation, rely on cultural and environmental factors. This study aimed to develop a questionnaire based on the occupational therapy practice frame to accurately evaluate Iranian children's occupational performance. Methods: This scale was developed in two phases of planning and construction. The planning phase involved a literature review and a collection of the available evaluation tools in the area. The advice of two expert panels was used to develop a preliminary 87-item questionnaire. In the construction phase, 40 parents were surveyed to assess the popularity of the activities in Iran. After a face to content validation, the final version of the questionnaire was prepared with 93 items. Results: The final 93-item questionnaire was used to assess the ADL of 3-6-year-old children. The 93 items, selected according to criteria found in the literature and the panel of experts, were categorized into six ranges of occupational therapy practice framework (bathing/washing/personal hygiene, toileting, dressing, eating/feeding, functional mobility, and others). Conclusion: The ADL in Iranian children is a practical and culturally relevant tool for measuring the occupational performance of Iranian children. It can be used in clinical and population-based research. Highlights: ADLs are essential and routine tasks required to independent and healthy living.The active participation of the child in ADL during development has a positive effect on the development of sensory and cognitive functions of the brain.ADLs are highly dependent on contextual and ecological factors, such as parenting style, the environment and given context.The ADLIC tool is a standard, culturally adapted tool that can be used by occupational therapists to assess ADLS in Iranian children. Plain Language Summary: The ADLs referred to Self Care Skills, which play a major role in a child overall functional growth, confidence and independence. The healthy individuals can perform these life skills without assistance. The inability to accomplish essential ADLs may lead to unsafe conditions and poor quality of life. Due to the importance of these activities during the development of the child, it is necessary for Iranian children to be evaluated in terms of independence in these activities so that in case of disorder, the necessary counseling and education can be provided by occupational therapists.