Bravo Chris, Bringing our discussion into the empirical from the philosophical and I enjoyed part Two of your piece about practical ideas for treatment and that type of discussion...it helps people (including myself) think of different and new treatment ideas Brent C Original submittal: 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. ------------------------------ Message: 5 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
