Improving Clinician Communication through Action Research.

There are many challenges to interdisciplinary communication in home care. Management often takes a top-down approach, instructing home care clinicians on methods to improve communication. In this pretest-posttest intervention study, a bottom-up approach was taken using a focus group to allow home care clinicians to identify, develop, and implement strategies to share critical clinical and social information. The participants in the intervention group were compared with a control group who did not participate in the focus group. We found that empowering home care clinicians to develop strategies to improve interdisciplinary communication was beneficial in improving interdisciplinary collaboration. Actively involving home care clinicians in identifying issues and developing solutions may lead to improved collaboration.

Interventions to Address Cancer-Related Cognitive Impairment (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to cancer-related cognitive impairment in adults living with and beyond cancer.

Supporting Physical Activity in Adults Living With and Beyond Cancer (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on the effectiveness of interventions addressing physical activity in adults living with and beyond cancer.

Cancer-Related Fatigue (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to interventions addressing cancer-related fatigue in adults living with and beyond cancer.

Women's Experiences after Hormone Positive Breast Cancer: Beginning of Radiation to 3-4 Years Post-Radiation.

This study found that a breast cancer survivor cohort who were 3-4 years post-treatment returned to near baseline activity levels, and their important activity categories were nearly evenly distributed among instrumental activities of daily living, high-demand leisure, and social participation. When describing their experiences, three themes emerged: exercise is important physically and emotionally, participating in important activities feels good, and plans have been made to continue engaging in important activities. Further research is needed to compare activity resumption among those receiving or not receiving occupational therapy-at different timepoints-to understand when occupational therapy can make the greatest impact.

Twitter, Telepractice, and the COVID-19 Pandemic: A Social Media Content Analysis.

Purpose Telepractice was extensively utilized during the COVID-19 pandemic. Little is known about issues experienced during the wide-scale rollout of a service delivery model that was novel to many. Social media research is a way to unobtrusively analyze public communication, including during a health crisis. We investigated the characteristics of tweets about telepractice through the lens of an established health technology implementation framework. Results can help guide efforts to support and sustain telehealth beyond the pandemic context. Method We retrieved a historical Twitter data set containing tweets about telepractice from the early months of the pandemic. Tweets were analyzed using a concurrent mixed-methods content analysis design informed by the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Results Approximately 2,200 Twitter posts were retrieved, and 820 original tweets were analyzed qualitatively. Volume of tweets about telepractice increased in the early months of the pandemic. The largest group of Twitter users tweeting about telepractice was a group of clinical professionals. Tweet content reflected many, but not all, domains of the NASSS framework. Conclusions Twitter posting about telepractice increased during the pandemic. Although many tweets represented topics expected in technology implementation, some represented phenomena were potentially unique to speech-language pathology. Certain technology implementation topics, notably sustainability, were not found in the data. Implications for future telepractice implementation and further research are discussed.

Creating an Interprofessional Collaborative Research Opportunity for Physical and Occupational Therapy Students.

Physical therapy (PT) and occupational therapy (OT) professional associations assert the importance that entry-level therapists learn and apply the knowledge and skills necessary for interprofessional collaborative practice; however, the majority of PT and OT programs do not have the other discipline at their university. A challenge exists for the creation of a transparent active learning opportunity promoting interprofessional student engagement when the two professions do not reside in the same university. This case study provides a model for how to feasibly create an interprofessional experience for students in universities that do not include a complementary or collaborative allied health professional program, using various technologies. While creating this collaborative project, we provided opportunities to meet the Interprofessional Education Collaborative's (IPEC) competencies: a) value/ethics for interprofessional practice, b) roles and responsibilities, c) interprofessional communication, and d) teams and teamwork through participation in a breast cancer survivorship research study. Within this demonstration project, the faculty were able to make "micro level" changes to foster interprofessional collaboration among universities with other allied health profession programs, which may lead to improved health outcomes for our clients.

Safety and improvement of movement function after stroke with atomoxetine: A pilot randomized trial.

BACKGROUND: Intensive, task-oriented motor training has been associated with neuroplastic reorganization and improved upper extremity movement function after stroke. However, to optimize such training for people with moderate-to-severe movement impairment, pharmacological modulation of neuroplasticity may be needed as an adjuvant intervention. OBJECTIVE: Evaluate safety, as well as improvement in movement function, associated with motor training paired with a drug to upregulate neuroplasticity after stroke. METHODS: In this double-blind, randomized, placebo-controlled study, 12 subjects with chronic stroke received either atomoxetine or placebo paired with motor training. Safety was assessed using vital signs. Upper extremity movement function was assessed using Fugl-Meyer Assessment, Wolf Motor Function Test, and Action Research Arm Test at baseline, post-intervention, and 1-month follow-up. RESULTS: No significant between-groups differences were found in mean heart rate (95% CI, -12.4-22.6; p = 0.23), mean systolic blood pressure (95% CI, -1.7-29.6; p = 0.21), or mean diastolic blood pressure (95% CI, -10.4-13.3; p = 0.08). A statistically significant between-groups difference on Fugl-Meyer at post-intervention favored the atomoxetine group (95% CI, 1.6-12.7; p = 0.016). CONCLUSION: Atomoxetine combined with motor training appears safe and may optimize motor training outcomes after stroke.

Nerve Stimulation Enhances Task-Oriented Training in Chronic, Severe Motor Deficit After Stroke: A Randomized Trial.

BACKGROUND AND PURPOSE: A sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis. Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment (almost no active movement). METHODS: Subjects with chronic, severe poststroke hemiparesis (n=36) were randomized to receive 10 daily sessions of either active or sham stimulation (2 hours) immediately preceding intensive task-oriented training (4 hours). Upper extremity movement function was assessed using Fugl-Meyer Assessment (primary outcome measure), Wolf Motor Function Test, and Action Research Arm Test at baseline, immediately post intervention and at 1-month follow-up. RESULTS: Statistically significant difference between groups favored the active stimulation group on Fugl-Meyer at postintervention (95% confidence interval [CI], 1.1-6.9; P=0.008) and 1-month follow-up (95% CI, 0.6-8.3; P=0.025), Wolf Motor Function Test at postintervention (95% CI, -0.21 to -0.02; P=0.020), and Action Research Arm Test at postintervention (95% CI, 0.8-7.3; P=0.015) and 1-month follow-up (95% CI, 0.6-8.4; P=0.025). Only the active stimulation condition was associated with (1) statistically significant within-group benefit on all outcomes at 1-month follow-up and (2) improvement exceeding minimal detectable change, as well as minimal clinically significant difference, on ≥1 outcomes at ≥1 time points after intervention. CONCLUSIONS: After stroke, active peripheral nerve stimulation paired with intensive task-oriented training can effect significant improvement in severely impaired upper extremity movement function. Further confirmatory studies that consider a larger group, as well as longer follow-up, are needed. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02633215.

Oscillatory MEG motor activity reflects therapy-related plasticity in stroke patients.

BACKGROUND: A goal of stroke rehabilitation is to harness the capacity of the brain to reorganize following neurological damage and enable restoration of function. OBJECTIVE: To understand how neural oscillatory motor responses change following a therapeutic intervention and to illuminate whether these neurophysiological alterations correlate with improvements on behavioral measurements. METHODS: Magnetoencephalography (MEG) was used to evaluate plasticity in motor networks following 2 weeks of intensive task-oriented therapy, which was paired with sham or peripheral nerve stimulation (PNS). Patients completed unilateral finger tapping before and 3 weeks after therapy as whole-head MEG data were acquired. MEG data were imaged using beamforming, and the resulting event-related synchronizations and desynchronizations (ERSs/ERDs) were subjected to region-of-interest (ROI) analyses. For each ROI, the authors compared the baseline and postintervention MEG response amplitude, volume, and peak location for premovement ß ERD, movement-onset γ ERS, and postmovement ß ERS. RESULTS: Following therapy, all patients showed reduced postmovement ß ERS response amplitudes in bilateral precentral gyri and reduced γ ERS amplitudes in the precentral gyrus of the affected hemisphere. This latter response also distinguished treatment groups, as the posttherapy γ reduction was greater in patients who received PNS. Finally, both ß and γ response amplitudes were significantly correlated with improvement on several behavioral indices of motor function. DISCUSSION: These case-series data indicate that oscillatory MEG responses may be useful in gauging plasticity in motor cortices following therapy in stroke patients.

Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines.

Lower extremity lymphedema is an important medical issue which causes morbidity and is frequently seen by dermatologists. The subject has not been adequately addressed in dermatologic literature for many years. Primary lymphedema is caused by an inherent malfunction of the lymph-carrying channel, in which no direct outside cause can be found. Secondary lymphedema is caused by an outside force, such as tumors, scar tissue after radiation, or removal of lymph nodes, which results in dysfunction of the lymph-carrying channels. Treatment is based on rerouting the lymph fluid through remaining functional lymph vessels. This is accomplished through elevation, exercises, compression garments/devices, manual lymph drainage, and treatment is combined with good skin care practices.