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Occupational therapy practitioners are the perfect fit for the delivery of the interventions, supported by the most up to date evidence-based practice for each case that applied. The role of occupational therapy professionals must be in line with the new trends and appropriate services with clients. Traditional settings like inpatient rehabilitation facilities and emerging settings as the technology bring enormous support to the intervention, regarding clients who have survived a stroke; both settings are involved in the evaluation, treatment and recovery process. Current research describes the analysis of evidence-based review and relate the outcome of articles can directly validate clinical practices, combining with scientific evidence and clinical experience; taking into account the self-determination of the client.
Evidence-Based Practice, Supporting the Role of the Occupational Therapy Assistant in most Settings Occupational therapy assistant (OTA) plays an essential role while working either at traditional or emerging settings, for instance, inpatient rehabilitation facilities, hospitals, clinics, schools, and treatment centers (Stevens, 2010). Occupational therapy personnel, especially OTA, brings intervention services at inpatient rehabilitation facilities (IRF); these traditional settings are “freestanding facilities or rehabilitation units that provides intensive rehabilitation services to clients after an injury, illness or surgery” (Sechrist, 2016, p.451), OTA also works with clients, families, or caregivers to determine what activities are necessary for increase their quality of life. Current search proposes the correct interventions to improve activities of daily living, if the evidence-based practice review gives a positive outcome in the quality of the search, the proposed interventions will validate its application on adult patients with stroke.
Clients at the inpatient rehabilitation facilities must be able to participate three hours therapy per day minimum (Spaulding, 2016). Another setting that is useful to the stroke patient treatments is related to technology. Due to the great boom in technology, new trends have emerged in the use of therapies, providing a positive effect in the development of clients. This emerging setting is changing the way we interact, communicate, and live our daily lives, occupational therapy professionals will want to create innovative ways to use new technologies in their practice as an applicable emerging setting. According to the therapy’s theme, technology has efficiently improved to what has done nowadays so far, for example exert games promote good heart rate and movement, the increasable use of smartphones and tablets facilitate fine motor skills, sequencing, and to run text-to-speech programs. (Ifejika & Barrett, 2011).
During the last decades, mechanically assisted robotic training therapies have been developed for stroke rehabilitation to improve arm function (Ifejika & Barrett, 2011). As an emerging area, still there is a lot to do, practitioners of the occupational therapy should advocate for the fact to create and publish more evidence-based practice at recognized and accessible sources, either websites or databases. Several evidence-based practices reveal that clients could benefit with the correct interventions. The American Occupational Therapy Association has been working hard in the promotion of official sites to helping occupational therapy(OT) and OTAs to bring the most accurate evidence-based databases to ensure the quality in the provision of the services provided by OT practitioners. (Arbesman, Lieberman, & Berlanstein, 2015)
According to the National Stroke Association (2018) a stroke is a brain attack. It can happen to anyone at any time. It occurs when the bloodstream is cut off and does not get into the brain area; the brain cells do not receive enough oxygen and begin to die. Occupational therapy treatment uses purposeful activities to restore and maximize independence in activities of daily living (ADL), helps to prevent disability, and keeps people healthy. It includes experience with functional tasks to improve coordination, balance, cognitive abilities, strength, and range of motion. (CMS.gov, 2012). For clients that have suffered a stroke, these are some of the most effective interventions to improve activities of their daily living. Occupation-based interventions to improve activities of daily living (ADLs), repetitive task practice to enhance arm and hand function, visual scanning training to improve performance and compensate for unilateral neglect and action observation combined with task practice to promote self-directed independent practice. (Nilsen, Gillen & Lieberman, 2015). After the application of the aforementioned interventions, it is expected that adult patients with stroke show a functional increase and will be able to achieve their personal independence.
This evidence-based review primarily examined the evidence supporting the mentioned occupations in patients poststroke. Some studies met the inclusion criteria to support the relationship between the proposed interventions to improve activities of daily living, (Wolf et al., 2015), if the evidence-based practice review gives a positive outcome in the quality of the search, the proposed interventions will validate its application on adult patients with stroke.
The appropriate terminology was selected to obtain pertinent and relevant articles in Databases like PsycINFO, CINAHL, AgeLine, and OT seeker. Using the inclusion and exclusion criteria facilitate the organization of the review process which included 12,674 abstracts and citations and 273 articles resulted at the final review after the validation of them according to objectivity and quality. It was included studies with levels I, II, III evidence, levels IV and V evidence was not found (Arbesman et al., 2015). As a result of the evidence-based reviewed, the evidence regarding motor impairments showed a relationship with the task oriented training(TOT) using objects in natural environment, TOT combined with cognitive strategies and strengthening (Arbesman et al., 2015). In addition, categories of occupation like ADLs, IADLs, leisure, social participation and rest and sleep were selected based in the context of service delivery (Arbesman et al., 2015).
Taking into account that occupational therapy practitioners work with clients, families or caregivers to determine what activities are necessary for increase their quality of life, the analysis carried out a positive result according to the evidence-based practices found, and confirmed that the use of the proposed interventions is effective and applicable to serve in adult clients with stroke to enhance their activities of daily living at inpatient rehabilitation facilities or other facilities where occupational therapy services are provided. In addition, the implementation of the proposed interventions could provide an excellent guide for practitioners of occupational therapy when providing services to patients with stroke. The amount of evidence regarding specific interventions, however, is limited. More research is needed to allow OT-based testing for stroke patients. The results described in these articles can be applied directly in clinical practice combining scientific evidence with clinical experience and considering the self-determination of the client.
After the detailed review of the article, it is advisable to search more evidence- based practice in order to understand the correct relationship between traditional and emerging settings. As a professional of the occupational therapy field, the use of the technology applied to the clients with stroke will support the article and it would definitely be one worthy theme to advocate for.
1. Arbesman, M., Lieberman, D., & Berlanstein, D. R. (2015). Method for the evidence-based reviews on occupational therapy and stroke. American Journal of Occupational Therapy, 69(1), 1-5. doi:10.5014/ajot.2015.013524CMS.
2. gov. (2012). Center for medicare & medicaid services. Retrieve from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/InpatientRehab.htmlIfejika
3. N. & Barrett, A. (2011). Rehabilitation emerging technologies, innovative therapies, and future objectives. Retrieve from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148149/
4. National Stroke Association (2018). Hope after stroke. Retrieve from http://www.stroke.org/understand-stroke/what-stroke.
5. Nilsen, D., Gillen, G., Arbesman, M., & Lieberman, D. (2015). Occupational therapy interventions for adults with stroke. American Journal of Occupational Therapy, 69(5), 1-3. doi:10.5014/ajot.2015.695002
6. Sechrist D. M. (2016). Rehabilitation, disability, and participation and the discharge planning process. In A. Wagenfeld (Ed.), Foundations of theory and practice for the occupational therapy assistant (pp. 451-460).
7. Philadelphia, PA: Walters Kluwer.Spaulding. (2016). Rehabilitation network. locations. Retrieve from http://spauldingrehab.org/locations/inpatient-rehabilitation-facilities.
8. Stevens, A. (April 27, 2010). COTA: Role of a certified occupational therapy assistant. Retrieved from http://blog.sunbeltstaffing.com/therapy/cota-role-of-a-certified-occupational-therapy-assistant.
9. Wolf, T. J., Chuh, A., Floyd, T., McInnis, K., & Williams, E. (2015). Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review. The American Journal of Occupational Therapy, 69(1), 1-3A.
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