Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Stroke; Quality Improvement and Implementation Science
To improve the knowledge base of OT practitioners by: 1) reviewing evidence-based interventions for adults with HH and 2) illustrating implementation of such approaches through a successful case example.
Design : This involved an intervention case study with before and after assessments completed within a three-month period of treatment.
Setting : The study occurred within a private post-acute brain-injury rehabilitation setting.
Participants (or Animals, Specimens, Cadavers) : The subject of the study was a 66-year-old Caucasian female who sustained a stroke one month prior to her admission on referral from a physician.
Interventions included Visual Scanning Training (VST) that involved the following: right field awareness training, re-organizing environments to reduce fall risk and increase success with task completion, eye-hand coordination and dynamic scanning in a group setting to increase comfort with social participation, application of skills inside buildings and within the community, practice with adaptive equipment and strategies, and integration of multi-sensory experiences to support resumption of occupations with complex environmental demands.
Main Outcome Measure(s) :
Outcome Measures included: Pepper Visual Skills Reading Test, visuomotor response time, behind-the-wheel driving evaluation, and assessment of return to meaningful occupations.
Pepper-VSRT improved from 48 to 92 words per minute. Resumption of reading was possible with 90-degree book tilting. 3-paragraph pace improved from 52 to 31 seconds. Visuomotor response time improved from 3.5 to 1.1 seconds. Subject was cleared to drive with some restrictions after hours of behind-the-wheel interventions with an OT specializing in driver rehabilitation. Subject successfully resumed living independently, cooking, and gardening.
Conclusions : OTs are uniquely equipped to teach individuals VST as a response to a positive assessment for HH. Individuals report greater confidence with occupations in their homes and communities as a result of evidence- and activity-based OT intervention.