|Year : 2018 | Volume
| Issue : 4 | Page : 109-110
Guest Editorial: Neurorehabilitation and functional ability: Opportunities for occupational therapy in transferring evidence from clinic to community
Kinsuk Maitra, Emily Buchman
Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
|Date of Web Publication||6-Feb-2019|
Dr. Kinsuk Maitra
Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maitra K, Buchman E. Guest Editorial: Neurorehabilitation and functional ability: Opportunities for occupational therapy in transferring evidence from clinic to community. Indian J Occup Ther 2018;50:109-10
|How to cite this URL:|
Maitra K, Buchman E. Guest Editorial: Neurorehabilitation and functional ability: Opportunities for occupational therapy in transferring evidence from clinic to community. Indian J Occup Ther [serial online] 2018 [cited 2019 Feb 20];50:109-10. Available from: http://www.ijotonweb.org/text.asp?2018/50/4/109/251762
Occupational therapy centers around the theoretical concept of “occupation.” Although a number of discourses try to explain the nature and definition of occupation, to us, it simply means how one is doing something that is meaningful and purposeful. In this sense, the term “occupation” has a time, space, and function concept built into it. For example, a person is preparing dinner in his/her kitchen in the evening, which is meaningful and purposeful for the person and the family. A person's daily life, monthly life, or even yearly life is composed of various discrete occupations that make the person a productive member of society in his or her own valuation. Through these occupations, a person establishes a bi-directional bridge with the society where the person gives some to the society and takes some from the society. When a condition or disease alters this reciprocity, there is a need for intervention to repair the bridge. One of the main functions of occupational therapy is to repair this societal bridge to make a person again a functional, productive member of society in the face of societal expectations and constraints. Therefore, the role of occupational therapy is vital to occupy a position that interfaces functional ability and social participation.
Disorders in the central nervous system (CNS) such as stroke, Parkinson's disease, traumatic and nontraumatic spinal cord injury, and traumatic brain injury cause a range and variety of functional movement difficulties (e.g., control in gait, balance, and posture) and cognitive difficulties (e.g., memory, judgment, and attention). These cognitive and motor challenges cause a person to be separated from the society and necessitate occupational therapy and other interventions to resume a functional and productive role within the society. Under the occupational therapy premise, the development of successful strategies requires a deeper understanding of the neuropathology of the disease or condition and how the underlying pathology affects the function and quality of daily life overall.
The last two decades has seen an explosion of experimental and clinical approaches to understanding the integrated control of movement and balance, including a variety of neurorehabilitation strategies to improve motor learning and control. The overall goal of this line of research is to improve functional outcomes and societal integration for people living with CNS system impairment. To this end, this issue presents a cluster of articles representing a selection of approaches that aim to transfer learned principles in laboratory settings to clinical settings. A majority of the contributions explore the feasibility and efficacy of novel training strategies under the guiding principles of occupational therapy to improve balance and gait in CNS impairment. A case report addresses the development of assistive technology in aiding mobility for a pediatric client with a spinal cord condition, and another article reviews the existing outcome measures used in India for stroke.
Mohan and Sahu set the stage by investigating the effect of spacing technique coupled with conventional occupational therapy compared to the effect of conventional occupational therapy alone in improving impaired balance and gait in control people poststroke. One of the fundamental aspects of neurorehabilitation training is to follow the principles of motor learning, which is to essentially practice repetitions to form stronger memory (Smith and Scarf). A lot of work has been done in the laboratory over the past few decades on the variables that influence the conditions of practice. One of the variables that has been studied quite extensively is the so-called “spacing effect.” The spacing effect is the observation that practice repetitions spaced over time tend to produce stronger memories, and therefore enhanced motor learning, compared to repetitions massed closer together in time (Smith and Scarf). Translation of the knowledge of spacing technique in neurorehabilitation is limited but is warranted. The authors found that, when spacing technique was introduced with the conventional occupational therapy, statistically significant improvement in balance and gait occurred in patients with stroke.
Mani and Sundar conducted a scoping review to find out the outcome measures used in the rehabilitation of stroke in India. They found that Modified Rankin Scale and Barthel Index were the most commonly used outcome measures. Only two of the identified measures were developed in the India-Bengali version of the Mini–Mental Status Examination and Kolkata Cognitive Screening Battery. A scoping review, rather than a systematic review or meta-analysis, is conducted when it is assumed that there are few studies in the field. This scoping review is conducted to assess the scope (nature, range, and extent) and gap in research activities in a field. Any rehabilitation process is examined through two most important lenses, that is, process outcome and end outcome. Process outcome measures generally focus on the process of rehabilitation training such as the type of training, staff composition, time, and space. On the other hand, end outcome measures, commonly called simply outcome measures, look at the end results that define the success of the rehabilitation process. In this sense, outcome measures are extremely important, and standardized outcome measures across facilities provide a uniform view of the process in a region, a state, or a country. The other important aspect of the outcome measures is the enculturation of the outcome measures in a specific culture and country. Therefore, developing an Indian version of popular occupational therapy outcome measures in the Western hemisphere is extremely important to capture the cultural aspect of life because occupational therapy places importance on the function of individuals in a society and successful community integration following a CNS impairment. It is sobering to see that only two Indian versions of outcome measures have been developed; work should be devoted to developing more.
Sahu, Jali, and Srivastava examined the effect of dual-task training in reducing falls and fear of falling in patients with Parkinson's disease in a longitudinal study. Dual-task training is gaining importance in addressing postural and equilibrium problems resulting from CNS impairment. In the dual-task paradigm, a patient is acutely directed often to a cognitive task (like counting or a simple arithmetic manipulation) while performing a motor task like gait. According to the constrained action hypothesis, attentional change due to cognitive loading may force the motor system to function on an automatic drive, thereby resulting in more effective performance. In fact, studies involving the dual-task paradigm have published results showing significant improvement in motor and cognitive performance for individuals prone to falling., In the current study, similar improvements in falls and fear of falling were found in patients with Parkinson's disease, a condition marked by postural instability.
Patil examined an interesting observation that patients with Parkinson's disease preserve the ability to ride a bicycle despite problems with freezing. In this brief review, Patil observed that few studies over a 10-year period addressed this issue, but it may be of importance to explore in future studies. It will be an interesting read to stimulate thought.
Bongade, Jaywant, and Yeradkar reported designing a chair to improve mobility and social participation of children with myelomeningocele. Assistive technology is a significant part of occupational therapy, and designing equipment to increase functional mobility is always a welcome report so that others can consider the possibilities.
Finally, Khan and Singh conducted a study comparing the use of splinting and exercise as interventions to reduce spasticity and improve hand function in patients with stroke. Although both interventions demonstrated improved outcomes, neither intervention was shown to be more effective than the other. Comparison studies like this one are becoming extremely important for increasing cost-effectiveness and improving function.
Taken together, these articles underscore the importance of client-centered studies to improve functional outcomes and social and community integration. All these studies looked at the specific techniques or paradigms in solving some of the central problems in neurorehabilitation. It is very important to conduct these and other types of studies to transfer knowledge from laboratory settings to clinical rehabilitation settings. One of the important aspects of transfer of knowledge we need to remember is that, given the variety of motor issues that are encountered in the clinical setting, modification and adaptation of laboratory techniques are necessary to increase generalizability.
| References|| |
Wolf TJ, Chuh A, Floyd T, McInnis K, Williams E. Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review. Am J Occup Ther 2015;69:6901180060p1-11.
Smith CD, Scarf D. Spacing repetitions over long timescales: A review and a reconsolidation explanation. Front Psychol 2017;8:962.
Ghai S, Ghai I, Effenberg AO. Effects of dual tasks and dual-task training on postural stability: A systematic review and meta-analysis. Clin Interv Aging 2017;12:557-77.
Mishra N. Comparison of effects of mental imagery, cognitive and motor dual task training methods on gait and balance of stroke survivors. Indian J Occup Ther 2015;47:46-51.