Examining the Relevance of Neurological Frames of Reference in Regional Practice of Stroke Rehabilitation

Mylene Schriner, PhD, OTR/L; Madie Bahlinger, OTS; Katie Neil, OTS; Lindsey Pollock, OTS; Nikki Rosenhauer, OTS; Colleen Schneider, OTS

Department of Occupational Therapy Education, Rockhurst University, Kansas City, MO

Background Methods

Discussion

Conclusions

Results

Purpose Acknowledgements

•  Currently 7 million people live with detrimental effects from surviving a stroke (National Stroke Foundation, 2013).

•  Those working within rehabilitation services need to develop appropriate intervention techniques which lead to individual success (Delaney, 1983).

•  In order to ensure success of occupational therapy students on fieldwork and in practice, occupational therapy (OT) faculty should consider whether current curriculum is relevant to stroke rehabilitation.

•  Neurological frames of reference (FoRs) supply occupational therapists (OTs) with intervention techniques for treatment, leading to successful outcomes.

•  The following FoRs taught in the current OT curriculum include: •  Brunnstrom, which uses reflexes and primitive movement patterns to facilitate

recovery of voluntary movement. •  Constraint-Induced Movement Therapy (CIMT), which requires use of the

affected extremity in daily activities by restraining the non-affected extremity. •  Neurodevelopmental Treatment (NDT), which concentrates on eliminating

abnormal patterns of muscle tone and motor control to restore normal movement patterns.

•  Proprioceptive Neuromuscular Facilitation (PNF), which stresses passive and active-assisted movement in diagonal patterns of flexion and extension.

•  Rood, which uses reflex arcs to elicit motor responses by supplying sensory stimulation in a controlled way.

•  Task-Oriented approach, which focuses primarily on meaningful tasks and functional goals through the use of real objects and natural environments.

•  A 2012 study showed universities on coastal regions (CR) had superior master’s programs compared to Midwest (MW) universities (Washington Monthly, 2012).

•  It is important to analyze the differences of neurological FoRs OTs teach and implement into practice in different regions of the United States.

•  This is a continuation of a 2012 study which surveyed OTs and neurological intervention use in the MW (Brightman et al., 2012).

•  Sample size of CR =96 and MW =167. Participants completed a 33 question online survey (SurveyMonkey). Questions included demographics and OT intervention questions . Participants rated frequency of intervention techniques based upon the six neurological FoRs, which remained hidden throughout the survey.

•  Responses concerning techniques used a 4-point Likert scale defined as “usually (4)”, “sometimes (3)”, “rarely (2)”, and “almost never (1)”.

•  Participants received invitations through email or web postings via OT state associations, alumni and fieldwork sites associated with OT and OTA programs located on the coasts, and OT organizations through social media.

•  Data was analyzed using IBM® SPSS® Statistics version 19.0.

The authors thank the following faculty members for their contributions: Michael Clump, PhD Liz Zayat, MS, OTR/L Catherine Thompson, PhD, PT, MS Katie Ryan, PhD, OTR

The purpose of this study is to establish frequency of neurological interventions in OT practice on the CR, if differences exist between the MW and CR regarding frequency, and curriculum accuracy.

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•  Figure 1 displays results of an independent t-test that reveals the CR used Brunnstrom, NDT, and Task Oriented significantly more than the MW.

•  Figure 2 demonstrates, based on frequency statistics, OTs on the CR gained knowledge from work experience foremost, followed by fieldwork experience and lastly OT education (according to Likert scores of 3.917, 3.313, and 3.146 respectively).

•  Survey results exposed NDT and Task Oriented as the most frequently used FoRs in MW and CR alike.

•  Frequency data indicated Rood as the least used frame of reference (FoR) among both MW and CR.

•  Results showed that CR use NDT, Brunnstrom, and Task Oriented significantly more than the MW with no significant differences between the remaining FoRs.

•  Figure 2 displays evidence that OTs gain knowledge for intervention planning in upper extremity rehabilitation from a variety of sources.

•  No correlations exist between FoR use and years since graduation and years of experience in stroke rehabilitation.

•  Limitations of the study include: •  Errors with data collection and formatting of SurveyMonkey. •  Difficulties soliciting survey participants in the CR. •  Honesty and accuracy in self-evaluations of respondents regarding FoRs

use.

•  OTs in the CR use NDT, Brunnstrom, and Task Oriented significantly more than MW in stroke rehabilitation.

•  OTs use an eclectic approach when gathering knowledge for treatment interventions.

•  The MW and CR equally use a variety of FoRs when determining treatment for upper extremity stroke rehabilitation.