title: Motor Learning and the Use of Videotape Feedback After Stroke Performance Problems of Patients With Chronic Low-Back Pain and the Measurement of Patient-Centered Outcome A randomized controlled trial of routines-based early intervention for children with or at risk for developmental delay. A pilot cluster randomized controlled trial of structured goal-setting following stroke Reliability of the Canadian Occupational Performance Measure in patients with ankylosing spondylitis. Evaluation of a pilot service designed to provide support following stroke: a randomized cross-over design study Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke. Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident. The effect of intense physical therapy for children with cerebral palsy. Reliability and validity of the Canadian Occupat189ional Performance Measure in stroke patients Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial Effect of imagery perspective on occupational performance after stroke: a randomized controlled trial.
abstract: Abstract Background : Efforts have been made to apply motor learning theories to the rehabilitation of individuals following stroke .  Motor learning poststroke has not been well investigated in the literature . This research attempted to fill the gap regarding motor learning applied to practice . Purpose : This two-group research study attempted to determine the effectiveness of an experimental therapy combining videotape feedback with occupational therapy compared to only occupational therapy in learning the motor skill of donning socks and shoes after stroke . Method : Ten participants were r and omly assigned to one of the two groups and all participants were videotaped during pretest and up to 10 treatment sessions aim ed at donning socks and shoes . Only one group viewed their videotape replay . The acquisition of donning socks and shoes was measured using the socks and shoes subtests of the Klein-Bell Activities of Daily Living Scale and their scores on the Canadian Occupational Performance Measure . Results : There was no significant difference between the two groups and both groups improved . However , the group that received videotape feedback thought they performed better and were more satisfied with their ability to don shoes , lending support for the use of videotape feedback poststroke to improve satisfaction with performance Study Design . In a prospect i ve interventional study , problems with performance were evaluated in 101 consecutive patients with chronic low-back pain for more than 12 months , before and after participation in an outpatient-based multidisciplinary pain management program in Mansfield , United Kingdom . Objectives . To describe problems identified as most important by patients with chronic low-back pain and to evaluate the Canadian Occupational Performance Measure ( COPM ) as a tool for measuring problem-specific outcomes . Summary of Background Data . Patients with chronic low-back pain report difficulties with a variety of activities . The COPM permits the identification and measurement of problems of particular concern to the patient . Material s and Methods .  COPM , likert-modified Rol and and Morris Disability Question naire , Pain Self-Efficacy Question naire , and 5-minute walk test  were administered at baseline , immediately after , and 9 months after intervention . Differences and statistical interactions were determined by nonparametric tests . Results . Participants identified 60 different types of problem activity , 45 of which were identified by nine or fewer participants . Decreased walking tolerance was the most frequently identified problem ( 56 % of participants ) . Improvements were observed in all outcomes following intervention . Approximately one third of participants reported improvements two or more COPM units in overall performance and satisfaction with their performance at 9 months . Higher reported performance and satisfaction were associated with greater self-efficacy . Increased reported walking performance was associated with increased observed 5-minute walk distance ( R = 0.35 , P = 0.02 ) . Conclusions . Patients with chronic low-back pain report problems with diverse activities . The COPM provides a patient-centered outcome measure that displays good external validity and responsiveness to change when addressing the individual ’s goals Routines-based early intervention ( RBEI ) for children with or at risk for developmental delay encourages collaboration between professionals and families to enhance children 's participation in family routines with family-selected goals . We conducted the first single-blinded r and omized control trial to examine the effectiveness of a 6-month RBEI vs. traditional home visiting ( THV ) , which uses a curriculum focused on children 's developmental domains . Thirty-one families with children aged 5 - 30 months ( mean age 17.4 months ) with or at risk for developmental delay were r and omly assigned to an RBEI group ( n=15 ) or a THV group ( n=16 ) . The enrolled children were evaluated using the Chinese version of Pediatric Evaluation of Disability Inventory ( PEDI-C ) and the Comprehensive Development Inventory for Infants and Toddlers ( CDIIT ) at 5 time points . Two-way mixed analysis of variance ( ANOVA ) was used to examine the group by stage interactions . Goal Attainment Scaling ( GAS ) and the Canadian Occupational Performance Measure ( COPM ) were applied to explore between-group differences on individualized goal achievement . PEDI-C showed that the RBEI group had a faster progress rate in self-care functions and independence in social functions in the first 3 months of intervention and at the 6-month follow-up . The RBEI group also scored higher on the GAS in the first 3 months of intervention . However , between-group differences in changes in the developmental domains on the CDIIT were not significant . Thus , RBEI was more effective than THV in promoting functional outcomes and reaching family-selected goals , while both interventions allowed equal improvement in developmental domains Objective : To determine the feasibility , the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal - setting . Design : A cluster r and omized controlled trial . Setting : Inpatient rehabilitation facilities . Subjects : People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal - setting and complete the primary outcome measure . Interventions : Structured goal elicitation using the Canadian Occupational Performance Measure . Main measures : Quality of life at 12 weeks using the Schedule for Individualised Quality of Life ( SEIQOL-DW ) , Functional Independence Measure , Short Form 36 and Patient Perception of Rehabilitation ( measuring satisfaction with rehabilitation ) . Assessors were blinded to the intervention . Results : Four rehabilitation services and 41 patients were r and omized . We found high values of the intraclass correlation for the outcome measures ( ranging from 0.03 to 0.40 ) and high variance of the SEIQOL-DW ( SD 19.6 ) in relation to the minimally importance difference of 2.1 , leading to impractically large sample size requirements for a cluster r and omized design . Conclusions : A cluster r and omized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal - setting . Other techniques for coping with contamination effects are necessary OBJECTIVE The Canadian Occupational Performance Measure ( COPM ) is a client-centered measure , design ed to detect changes in occupational performance over time . The main aim of our study was to examine the test-retest reliability of the Norwegian version of the COPM in patients with ankylosing spondylitis ( AS ) in 3 different retest modes of data collection . METHODS A total of 119 patients with AS completed the baseline COPM interview before r and omization into one of 3 modes of retest data collection performed 2 weeks later : by personal interview , telephone interview , or mailed question naire . Scores were computed for Performance and Satisfaction , and the 2 sets of scores were examined for reliability by intraclass correlations ( ICC ) , and by the Bl and -Altman procedure for calculation of smallest detectable difference ( SDD ) . RESULTS The ICC coefficients for Performance and Satisfaction were as follows : 0.92 and 0.93 ( rescoring by personal interview ) , 0.73 and 0.73 ( rescoring by telephone interview ) , and 0.90 and 0.90 ( rescoring by mail ) . SDD for the Performance and Satisfaction scores were 1.47 and 1.80 , respectively , for rescoring by personal interview ; 3.14 and 4.00 for rescoring by telephone interview ; and 2.20 and 2.41 for rescoring by mailed survey . CONCLUSION The results confirm that the COPM is a reliable instrument for use in clinical practice in patients with AS , and may serve as an instrument to promote a patient-centered approach in the planning and evaluation of rehabilitation programs . Mailed question naires may replace personal interview in followup examinations , while rescoring by telephone interview is less reliable Objective : To evaluate a day service for people aged 18–55 years who had a stroke . Design : A r and omized cross-over study design was used , r and omly allocating individuals to attend the service for six months followed by a period of no attendance for six months . Setting : A day service pilot project was launched in Cardiff in July 1995 for people who were aged between 18 and 55 years and had a stroke . It met one day a week . Subjects : Twenty-six participants were recruited to the study between June 1998 and February 2000 . Their mean age was 48 years ( SD = 7 ) . Interventions : The service aim ed to offer participants the opportunity to identify and pursue meaningful and realistic opportunities within the community . A range of activities occurred at the service including creative activities and social outings . Main outcome measures : The Barthel ADL Index , Extended ADL Scale , Nottingham Leisure Question naire , Short Form 36 , the Hospital Anxiety and Depression Scale , the Canadian Occupational Performance Measure , the Role Checklist and the Semantic Differential Self Concept Scale were used to assess the outcomes from the service . Results : Attending the service  increased occupational performance and satisfaction with performance but there was no evidence that depression and anxiety were reduced or that quality of life and self-concept were improved . Conclusion : Although there were some gains from attending the service there were also many unmet needs . Further research is required to continue to identify how best to meet the needs of individuals post stroke under retirement age OBJECTIVE The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance ( CO-OP ) intervention or st and ard occupational therapy ( SOT ) to determine the magnitude and direction of change . METHOD Eight people living in the community following a stroke were r and omly assigned to receive CO-OP ( n = 4 ) or SOT ( n = 4 ) . CO-OP is a 10-session , cognitive-oriented approach to improving performance that uses client-driven cognitive strategies . SOT was therapist driven and combined task-specific and component-based training . Goal performance was measured by the therapist-rated Performance Quality Rating Scale ( PQRS ) and the participant-rated Canadian Occupational Performance Measure ( COPM ) . RESULTS Using Mann-Whitney U test , we found that CO-OP participants showed significantly greater improvement in performance ( PQRS , p = .02 ; COPM Performance , p = .02 ) compared with SOT but no improvement in satisfaction ( COPM Satisfaction , p = .38 ) . CONCLUSION The CO-OP group demonstrated larger performance improvements than the SOT group . Because of the promising results , an investigation using a larger sample is warranted OBJECTIVE We compared the effectiveness of constraint-induced movement therapy ( CIMT ) with bilateral treatment of equal intensity for chronic upper-extremity ( UE ) dysfunction caused by cerebrovascular accident ( CVA ) . DESIGN We conducted a 2-group , r and omized intervention trial with stratification by severity of UE dysfunction . Twelve community-dwelling adults were provided with 6 hr of occupational therapy for 10 days plus additional home practice . Six participants wore a mitt on the unimpaired UE , and 6 participants were intrusively and repetitively cued to use both UEs . The Wolf Motor Function Test ( WMFT ) and the Canadian Occupational Performance Measure ( COPM ) were administered before and after treatment and at 6-mo follow-up . RESULTS Significant improvements were found in WMFT and COPM scores across time in both groups . No significant between-group differences were found on the WMFT . CONCLUSION High-intensity occupational therapy using a CIMT or a bilateral approach can improve UE function  in people with chronic UE dysfunction after CVA . Treatment intensity rather than restraint may be the critical therapeutic factor PURPOSE To determine the effect of an intense physical therapy intervention on gross motor function , community walking and participation in children with cerebral palsy ( CP ) . METHODS A single group design was used with two pre-test and two post-test measures . Subjects were 17 ambulatory children with CP who participated in an intense intervention  ( i.e. , four hours per day , five days per week , three weeks ) , a modified version of the TheraSuit protocol .  Gross motor function measure ( GMFM-66 ) , Step watch activity monitor ( SAM ) , Canadian occupational performance measure ( COPM ) and pediatric outcomes data collection instrument ( PODCI ) were tested twice at baseline , immediately following the intervention , and three months later . RESULTS Immediately following the intervention , GMFM-66 , COPM and PODCI scores improved significantly ( p < 0.001 ) . At three months , improvements remained for GMFM-66 and COPM ( p < 0.01 ) . Walking amount or intensity ( SAM ) did not improve . CONCLUSIONS Participants improved gross motor skills and participation but not community ambulation following this intense physical therapy intervention Objective : To research test – retest reliability and discriminant validity of the Canadian Occupational Performance Measure ( COPM ) , a client-centred outcome measure , in stroke patients . Design : The COPM was administered twice with a mean interval of eight days ( SD 2.5 , range 5–16 ) . On both occasions the patient identified a maximum of five problems in daily activities . The problems of both interviews were compared . The problems identified during the first COPM were rated by the patient on a performance and satisfaction rating scale on both occasions . The individually identified items with use of the client-centred COPM were compared with the fixed items of st and ardized measures ( Barthel Index , Frenchay Activities Index , Stroke Adapted Sickness Impact Profile-30 , Euroqol 5D and Rankin Scale ) . Setting : Patients were interviewed at their place of residence . Subjects : Twenty-six stroke patients participated , 11 men and 15 women , aged from 26 to 83 years ( mean 68 , SD 15 ) . Twenty-four patients were six months , two patients were two months post stroke . Results : Of the 115 problems identified during the first COPM , 64 ( 56 % ) were also identified the second time . Correlation coefficients for the scores were 0.89 ( p < 0.001 ) for performance and 0.88 ( p < 0.001 ) for satisfaction . Of the individual problems identified with the COPM , 25 % or less were present in the st and ardized measures . Correlations between the scores on the COPM and the st and ardized measures were low and nonsignificant , while all st and ardized measures correlated significantly with each other . Conclusions : Test – retest reliability of the COPM was moderate for the item pool but was good for the performance and satisfaction scores . Discriminant validity was confirmed . Many patient-unique problems identified with the COPM were not evaluated by st and ardized measures Objective : To compare the efficacy of a repetitive task-specific practice regimen integrating a portable , electromyography-controlled brace called the ‘ Myomo ’ versus usual care repetitive task-specific practice in subjects with chronic , moderate upper extremity impairment . Subjects : Sixteen subjects ( 7 males ; mean age 57.0 ± 11.02 years ; mean time post stroke 75.0 ± 87.63 months ; 5 left-sided strokes ) exhibiting chronic , stable , moderate upper extremity impairment . Interventions : Subjects were administered repetitive task-specific practice in which they participated in valued , functional tasks using their paretic upper extremities . Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration , occurring 3 days/week for eight weeks . One group participated in repetitive task-specific practice entirely while wearing the portable robotic , while the other performed the same activity regimen manually . Main outcome measures : The upper extremity Fugl-Meyer , Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention . Results : After intervention , groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points ; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales , including a 12.5-point increase on the Stroke Impact Scale recovery subscale . Conclusions : Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment OBJECTIVE This preliminary study sought to determine whether the imagery perspective used during mental practice ( MP ) differentially influenced performance outcomes after stroke . METHOD Nineteen participants with unilateral subacute stroke ( 9 men and 10 women , ages 28 - 77 ) were r and omly allocated to one of three groups . All groups received 30-min occupational therapy sessions 2 × /wk for 6 wk . Experimental groups received MP training in functional tasks using either an internal or an external perspective ; the control group received relaxation imagery training . Participants were pre- and posttested using the Fugl-Meyer Motor Assessment ( FMA ) , the Jebsen-Taylor Test of H and Function ( JTTHF ) , and the Canadian Occupational Performance Measure ( COPM ) . RESULTS At posttest , the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF ( p < .05 ) . All groups improved on the COPM ( p < .05 ) . CONCLUSION MP combined with occupational therapy improves upper-extremity recovery after stroke . MP does not appear to enhance self-perception of performance . This preliminary study suggests that imagery perspective may not be an important variable in MP interventions
target: Conclusion ] This review indicates that the Canadian Occupational Performance Measure is appropriate for clinicians , including physiotherapists , in assessing outcome for patients with stroke .
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