Try a new search

Format these results:

Searched for:

person:vanles01

in-biosketch:yes

Total Results:

8


Protocol for a remote home-based upper extremity self-training program for community-dwelling individuals after stroke

Kim, Grace J; Gahlot, Amanda; Magsombol, Camille; Waskiewicz, Margaret; Capasso, Nettie; Van Lew, Steve; Goverover, Yael; Dickson, Victoria V
BACKGROUND/UNASSIGNED:Half of all stroke survivors experience hemiparesis on the contralateral side, resulting in chronic upper extremity (UE) impairment. Remote rehabilitation is a promising approach to optimize the gains made in the clinic to maximize function and promote UE use at home. This paper describes the study protocol for a remote home-based UE self-training program. DESIGN/UNASSIGNED:This was a feasibility study that used a convergent mixed methods approach. METHODS/UNASSIGNED:We collected data on 15 community-dwelling individuals with UE hemiparesis after stroke. The study used motivational interviewing (MI) and ecological momentary assessments (EMA) to maximize engagement in a 4-week personalized UE self-training program. The study consisted of three phases: 1) training in MI for the interventionists 2) creating customized treatment plans using shared decision making, and 3) four weeks of UE self-training. MEASURES AND ANALYSIS/UNASSIGNED:To evaluate feasibility, we will summarize recruitment and retention rates, intervention delivery, acceptance, adherence, and safety. Quantitative UE outcomes will measure change in UE status after the intervention (Fugl-Meyer Assessment, Motor Activity Log, Canadian Occupational Performance Measure, and bilateral magnitude ratio). Qualitative data (1:1 semi-structured interviews) will capture participants' perceptions and experience with the intervention. Quantitative and qualitative data will be integrated to gain a deeper understanding of the facilitators and barriers for engagement and adherence to UE self-training. CONCLUSION/UNASSIGNED:The results of this study will advance the scientific knowledge for use of MI and EMA as methods for enhancing adherence and engagement in UE self-training in stroke rehabilitation. The ultimate impact of this research will be to improve UE recovery for individuals with stroke transitioning back into community. CLINICAL TRIALS REGISTRATION/UNASSIGNED:NCT05032638.
PMCID:10126840
PMID: 37113325
ISSN: 2451-8654
CID: 5465512

Convergent Validity for the Functional Upper Extremity Levels (FUEL) in Stroke Rehabilitation

Calajoe, Ashley; Feld-Glazman, Rachel; Dicembri, Adrienne; Capasso, Nettie; Geller, Daniel; Van Lew, Stephen
IMPORTANCE/OBJECTIVE:Research is needed to validate an easy-to-use, functional, evidence-based neurological upper extremity (UE) assessment that requires minimal training. OBJECTIVE:To establish convergent validity for the Functional Upper Extremity Levels (FUEL), a function-based upper limb measure, with the Upper Extremity Fugl-Meyer Assessment (UE-FMA), the gold standard assessment of upper limb recovery poststroke. DESIGN/METHODS:Retrospective chart review of 292 clients with admission and discharge data for the UE-FMA and the FUEL. Correlation statistics were analyzed to determine a relationship between these assessments. SETTING/METHODS:Inpatient stroke rehabilitation unit. PARTICIPANTS/METHODS:Clients with a stroke diagnosis admitted to the stroke inpatient rehabilitation unit at a rehabilitation hospital between January 2017 and June 2019. OUTCOMES AND MEASURES/METHODS:FUEL (a classification system) and UE-FMA (an impairment-based motor recovery assessment of the upper limb recovery poststroke). RESULTS:Pearson correlation coefficient yielded a significant positive correlation between the UE-FMA and the FUEL for both initial (r = .929) and discharge (r = .943) scores. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Convergent validity of the FUEL is established using the UE-FMA as a comparison. The FUEL can be applied in neurological rehabilitation to provide a clinical picture of a client's UE function. This research supports the value of the FUEL's application in clinical poststroke care. What This Article Adds: The FUEL is a valid tool to assess the UE in an acute neurological population.
PMID: 37272905
ISSN: 0272-9490
CID: 5541602

Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke

Geller, Daniel; Nilsen, Dawn M; Quinn, Lori; Van Lew, Stephen; Bayona, Claribell; Gillen, Glen
PURPOSE/UNASSIGNED:To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD/UNASSIGNED:Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS/UNASSIGNED:<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. CONCLUSIONS/UNASSIGNED:#NCT02780440Implications for RehabilitationHome-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke.Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.
PMID: 34538193
ISSN: 1464-5165
CID: 5012522

Establishing Criterion Validity for the Functional Upper-Extremity Levels (FUEL) in Comparison to the Fugl-Meyer To Classify Functional Motor Recovery in the Acute Stroke Population [Meeting Abstract]

Feld-Glazman, Rachel; Spinelli, Lisa; Foley, Ashley; Geller, Daniel; Van Lew, Steve; Dicembri, Adrienne; Capasso, Nettie
ISI:000496987600049
ISSN: 0272-9490
CID: 4222272

Occupational Therapy for Nonoperative Four-Part Proximal Humerus Fracture: A Case Report

Finley, William P; Van Lew, Steve
OBJECTIVE:Proximal humerus fractures are highly traumatic and debilitating. Surgical fixation may be contraindicated in older clients, thus requiring a systematic rehabilitation protocol. These clients may suffer loss of independence and require long-term assistance if not treated properly. METHOD:In this case report, we describe the occupation-based conservative rehabilitation of a retired male client after a four-part proximal humerus fracture. Outcome measurements used were the QuickDASH, the Numeric Rating Scale for Pain, goniometric measurements, and manual muscle testing. Repeated measures were used to collect data throughout a 12-mo period. RESULTS:Scores and measurements demonstrated improvement in all four outcome measures with clinically notable improvements achieved and maintained throughout the 12-mo period. The client reported a full return to activity. CONCLUSION:The techniques presented can be used by clinicians to create treatment plans, achievable functional goals, and realistic expectations for their clients. The protocol can aid clinicians in achieving objective milestones through occupation-based interventions.
PMID: 29689182
ISSN: 0272-9490
CID: 4337872

Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project

Corcoran, John R; Herbsman, Jodi M; Bushnik, Tamara; Van Lew, Steve; Stolfi, Angela; Parkin, Kate; McKenzie, Alison; Hall, Geoffrey W; Joseph, Waveney; Whiteson, Jonathan; Flanagan, Steven R
BACKGROUND: Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. In addition, Speech-Language Pathology rehabilitation was added to the early mobilization program. OBJECTIVE: 1. To assess the efficacy of early mobilization of patients with and without mechanical ventilation in the intensive care units (ICUs) on length of stay (LOS) and patient outcomes. 2. To determine the financial viability of the program. DESIGN: PIP. Prospective data collection in 2014 (PIP) compared to a historical patient population in 2012 (pre-PIP). SETTING: Medical and surgical ICUs of a Level 2 trauma hospital. PATIENTS: 160 in the PIP and 123 in the pre-PIP. INTERVENTIONS: Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the MICU and SICU for medically appropriate patients. MEASUREMENTS: Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; average cost per day. MAIN RESULTS: Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by more than 20% from 4.6 days (pre-PIP) to 3.8 days (PIP) (p=.05). A decrease of 30% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) (p<.01). An increased percentage of PIP patients, 40.5%, were discharged home without services compared to 18.2% in the pre-PIP phase (p<.01). Average cost per day in the ICU and floor bed decreased in the PIP group resulting in an annualized net cost savings of $1.5 million. CONCLUSIONS: The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early mobility studies focus on patients on mechanical ventilation. The results of this PIP project demonstrate that there are significant benefits to early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. Benefits include reduced hospitalization LOS, decreased health care costs and decreased need for post-acute care services.
PMID: 27346093
ISSN: 1934-1563
CID: 2166822

Development and Preliminary Reliability of the Functional Upper Extremity Levels (FUEL)

Van Lew, Stephen; Geller, Daniel; Feld-Glazman, Rachel; Capasso, Nettie; Dicembri, Adrienne; Zipp, Genevieve Pinto
OBJECTIVE: The Functional Upper Extremity Levels (FUEL) is a new classification tool to assess a person's upper-extremity functional and physical performance after sustaining a stroke. The aim of this preliminary study was to develop the tool and determine its content validity and interrater reliability. METHOD: Forty-four licensed occupational therapists ranging in years of experience from 6 mo to 16 yr participated in this study. A two-phase study was conducted: (1) constructing the FUEL and determining its content validity and (2) ascertaining its interrater reliability. RESULTS: We found that the FUEL had initial content validity and substantial interrater reliability (Fleiss kappa = .754). CONCLUSION: The FUEL can be a useful clinical and research tool in occupational therapy for the assessment and classification of upper-extremity function for people after stroke. Further studies with larger samples and comparison studies with other similar tools are required to support the tool's reliability and validity.
PMID: 26565105
ISSN: 0272-9490
CID: 1834882

Integrating the centennial vision into an evidence-based fieldwork-learning experience

Van Lew, Steve; Singh, Nandita
ABSTRACT Occupational Therapy's Centennial Vision includes the concept of evidence-based practice (EBP) as a core mechanism to move the profession forward. The literature reveals that although EBP has become an expected norm by occupational therapy consumers and payers, it is difficult to implement secondary to a variety of issues. The implementation and use of an EBP fieldwork experience within the physical disabilities context require problem-based and collaborative learning approaches. Fieldwork students complete 15 practitioner-facilitated EBP modules regarding performance approaches specific to the fieldwork site. The response of the participants suggests that EBP can have a positive impact on new knowledge acquisition and its application to new clinical skills. Future program goals include the development of more in-depth outcome measures to ascertain the effectiveness of a fieldwork clinical-learning module program.
PMID: 23898875
ISSN: 0738-0577
CID: 5155982