Sorry Ron but the great debate continue!!!!
There is a budding branch of research that does support the use of
impairment based OT to improve occupational outcomes post stroke. This
is a very short list, due to time constraints. I can offer more
research to you if you wantme to. I really enjoy research so I can
probably dig up tons of info if anyone esle is interested.
1) AOTA said this regarding Constraint Induced movement therapy in
their evidenced based bytes after an extensive review of the research:
“CIT, then, is strongly effective in improving behavioral outcomes. Its
effectiveness on impairments of dexterity, coordination, and strength
are most pronounced, whereas its effectiveness on ADL and participation
in greater amounts of activity is less. The latter finding needs
further study using reliable, objective, and more sensitive measuring
instruments. CIT does not appear to be contraindicated for patients who
are willing to enter into a behavioral contract to carry out the
stringent requirements of this treatment.”
(http://aota.org/Educate/Research/EB/Stroke/SFQ/37823.aspx)
***Sure the research states that ADL and participation was a less
significant change compared to improvements found when measuring the
impairments but non the less it was a significant change. This is at
least a start in the research.
2) CITATION: Jongbloed, L., Stacey, S., & Brighton, C. (1989). Stroke
rehabilitation: Sensor
imotor
integrative treatment versus functional treatment. American
Journal of Occupational Therapy, 43, 391-397
RESEARCH QUESTION
How does the effectiveness of two OT approaches to treatment of stroke
patients-the functional and sensorimotor integrative approaches-differ?
DESIGN
Randomized controlled trial (RCT)
Subjects were randomly assigned to one of two groups: Sensorimotor
Integrative or Functional
OUTCOME MEASURES
(R = Reliability established; V = Validity established)
Barthel Index - R, V
Meal Preperation - Reliability and validity not established
Eight Sensorimotor integration tests - R, V
INTERVENTION DESCRIPTION
Group 1: Functional Approach: Emphasizes the practice of tasks, usually
activities of daily living (ADL). The emphasis is on treatment of the
symptom rather than on the cause of the dysfunction. Two methods are
used: compensation and adaptation.
Group 2: Sensorimotor Integrative Approach: Emphasizes treating the
cause of the dysfunction rather than compensating for, or adapting to,
the problem. The principles that guided treatment were: (a) provide
planned and controlled sensory input; (b) elicit an adaptive response;
(c) enhance organization of brain mechanisms; and (d) facilitate the
developmental sequence.
INTERVENTION DESCRIPTION
Group 1: Functional Approach: Emphasizes the practice of tasks, usually
activities of daily living (ADL). The emphasis is on treatment of the
symptom rather than on the cause of the dysfunction. Two m
ethods
are used: compensation and adaptation.
Group 2: Sensorimotor Integrative Approach: Emphasizes treating the
cause of the dysfunction rather than compensating for, or adapting to,
the problem. The principles that guided treatment were: (a) provide
planned and controlled sensory input; (b) elicit an adaptive response;
(c) enhance organization of brain mechanisms; and (d) facilitate the
developmental sequence
AUTHORS' CONCLUSIONS
The authors concluded that if there are any differences between
functional treatment and sensorimotor integrative treatment they are
small. The findings suggest that occupational therapists can consider
using either approach in planning treatment for CVA patients.
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