Structured Abstract
Brain Injury Structured Abstract - BI #2
Functional activities may be slightly more effective than remedial activities in promoting fine motor coordination in adult men with brain injury
CITATION: Neistadt, M. E. (1994). The effects of different treatment activities on functional fine motor coordination in adults with brain injury. American Journal of Occupational Therapy, 48 (10), 877-882.
LEVEL OF EVIDENCE: IA2b
This randomized 2 group treatment comparison design study, sample size ranged above 20 per condition (22 remedial vs. 23 adaptive total 45) with moderate internal validity and moderate external validity provided a IA level of evidence.
RESEARCH OBJECTIVE/QUESTION
To compare the effects of individual food preparation training (adaptive treatment) and individual parquetry block assembly (remedial treatment) on constructional deficits in adult men with traumatic brain injury.
DESIGN
| |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
X |
Before-After |
|
Cross-Sectional |
This study design is used to evaluate a group of individuals who are undergoing the same treatment. Information regarding a group of people is collected both before and after treatment. This is a common design that is generally paralleled with a single case/individual study. A before-after design usually involves more than one person whereas a single case study may involve only one individual. Information was collected before the intervention phase began and the results tabulated after activities.
SAMPLING PROCEDURE
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Random |
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Consecutive |
| |
Controlled |
X |
Convenience |
Individuals were chosen strictly on a volunteer basis for completion of the study. Subjects were recruited from 10 brain injury programs in Massachusetts.
SAMPLE
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N = 45 |
M age = 33.2 |
Male = 45 |
Ethnicity = NR |
Female = 0 |
NR = Not reported
Clients were randomly assigned to either the adaptive or remedial treatment after meeting selection criteria. The Traumatic Brain Injury diagnosis was not well defined. The eligibility criteria were not restricted but wide. Participants were all male and ranged in age from 18 to 55 years. Participants' ethnicity was not reported. The participants' coma duration was not reported. The participants' average length of time since head injury was 7.9 years (SD = 6.6).
PARTICIPANT CHARACTERISTICS
Mixed Chronic TBI (open, closed, anoxic)
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury
OT TREATMENT DIAGNOSIS
Physical substrates: Sensory motor substrates: Motor coordination & dexterity: Fine motor incoordination, manipulation deficit, lack of dexterity.
OUTCOMES
Motor: Fine coordination/dexterity
|
Measures |
Reliability |
Validity |
|
1. Line Bisection Test |
NR |
NR |
|
2. Jebsen Hand Function Test |
0.91-.078 |
NR |
|
3. WAIS-R Block Design Subtest |
Test/Retest 0.92 |
NR |
|
4. Parquetry Block Test |
Test/Retest .92 |
NR |
|
5. RKE-R (Rabideau Kitchen Evaluation - Revised) |
Test/Retest .80 agreement 91% |
NR |
NR = Not Reported
Outcome - OT terminology
I. Performance Components
3. Motor
Fine Coordination
Dexterity
Outcome - ICIDH-2 terminology
Body Structure: Fine Coordination
INTERVENTION
Two treatment groups
1. Functional: Snacks & hot beverages
2. Remedial: Parquetry block assembly
Description
Functional Adaptive Treatment: Therapist provided training in the preparation of snacks and hot beverages using the same cueing procedures with all subjects.
Parquetry Block Assembly Remedial Treatment: Therapists provided training in parquetry block assembly using the same cueing procedure with all subjects.
Who delivered
Functional
16 Evaluators
13 Total consisting of:
Senior level occupational therapy students
Masters level occupational therapy students
0 Therapists
1 Rehabilitation counselor
Remedial
5 Treaters
Author (occupational therapist)
4 Masters level occupational therapy students
1 Occupational therapist
Setting
Functional
10 Long-term rehabilitation head injury centers in Massachusetts
Remedial
8 Centers were residential, 2 centers were outpatient
Frequency
3 Times a week, 30-minute sessions
Duration
6 weeks in addition to their regular rehabilitation program
Follow-up
Pre- and Post-treatment
RESULTS
Statistical Tests Used for Analysis: F test
Statistical Significance: p < .05 (see table 2, pg. 881) - mean change scores and standard deviation
Summarize Key Results: Significant difference (p < .05) on one of 4 outcomes measures (fine motor coordination) (2-group comparison)
- Simulate page turning (dominant hand) = .20, p = 0.65 S
- Simulate page turning (non-dominant hand) = 1.84, p = 0.182
- Pick-up small objects (dominant hand) = 5.23, p = 0.027*
- Pick-up small objects (non-dominant hand) = 1.27, p = 0.261
Simulated Page Turning with the dominant hand, with the non-dominate hand and Picking Up Small Objects with the non-dominant hand, there was no significant difference in improvement between the two treatment groups. For Picking Up Small Objects with the dominant hand, there was a significant difference in improvement between the two treatment groups, with the meal preparation group showing significantly more improvement than the parquetry block group.
CONCLUSIONS
Biases
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Attention |
X |
Masking/blinding |
|
Drop outs |
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Contamination |
X |
Co-intervention |
|
This study suggests that functional activities may be slightly more effective than tabletop activities In promoting fine coordination in persons with traumatic brain injury. Meal preparation has an advantage over the parquetry block task for dominant hand dexterity of objects.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
