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Self-Awareness and Recovery of Independence With Strategy Training.

ABSTRACT: Poor self-awareness co-occurs with cognitive impairments after stroke and may influence independence in daily activities. Strategy training promotes independence after stroke, but poor awareness may attenuate treatment response. We examined the degree to which awareness status affected changes in independence attributed to strategy training.We conducted a secondary analysis of 30 participants with cognitive impairments after acute stroke randomized to strategy training or attention control in addition to typical inpatient rehabilitation. We measured awareness with the Self-Awareness of Deficits Interview and independence with the FIM™. Data were analyzed using general linear models.Poor awareness attenuated improvements in independence over time, F(3, 55) = 3.04, p = .038. Strategy training promoted greater improvements in independence over time relative to attention control, F(3, 55) = 5.93, p = .002. However, the interaction between awareness and intervention was not significant, F(1, 19) = 0.025, p = .877.Awareness status may not affect the response to strategy training, indicating that strategy training may benefit people with poor awareness.

SUBMITTER: Skidmore ER

PROVIDER: S-EPMC5744716 | biostudies-literature | 2018 Jan/Feb

REPOSITORIES: biostudies-literature

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Self-Awareness and Recovery of Independence With Strategy Training.

Skidmore Elizabeth R ER Swafford Melissa M Juengst Shannon B SB Terhorst Lauren L

The American journal of occupational therapy : official publication of the American Occupational Therapy Association 20180101 1

<h4>Objective</h4>Poor self-awareness co-occurs with cognitive impairments after stroke and may influence independence in daily activities. Strategy training promotes independence after stroke, but poor awareness may attenuate treatment response. We examined the degree to which awareness status affected changes in independence attributed to strategy training.<h4>Method</h4>We conducted a secondary analysis of 30 participants with cognitive impairments after acute stroke randomized to strategy tr ...[more]

PMID: 29280726

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Project description:ImportanceSelf-awareness of deficits, or the ability to understand the effects of impairments on daily life, is often diminished after a stroke. Diminished self-awareness influences participation in rehabilitation and functional outcomes.ObjectiveTo examine whether self-awareness of deficits changed over time after a stroke (N = 43) and whether metacognitive strategy training (n = 21) resulted in improved self-awareness compared with direct skill training (n = 22).DesignSecondary analysis of data collected from a randomized controlled trial.SettingInpatient stroke rehabilitation.ParticipantsAdults with cognitive impairments after an acute stroke.InterventionMetacognitive strategy training is an approach in which clients are guided through a process of self-assessment and develop solutions for barriers to task performance. This approach was compared with direct skill training, in which the therapist provides specific instructions for task completion, removing the client-initiated assessment and problem-solving components.Outcomes and measuresSelf-awareness measures included the Self-Regulation Skills Interview and Self-Awareness of Deficits Interview at baseline and 3 mo and 6 mo after the intervention. We used a one-way analysis of variance (ANOVA) to analyze change in self-awareness and a two-way ANOVA to examine differences between groups over time.ResultsThere was a statistically significant and potentially meaningful difference over time in the self-awareness domain of strategy behavior, F(2) = 3.35, p = .039, but there were no differences in improvements between the metacognitive strategy and direct skill training groups.Conclusions and relevanceSelf-awareness warrants further investigation to determine whether it improves naturally over time or through both interventions after stroke.What this article addsSelf-awareness of deficits, and the use of strategies in particular, may improve in the early stages of stroke recovery, but the optimal approach for intervention remains unclear.

Project description:Objective: This study aims to evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson's disease (PD). Background: The phenomenon of impaired self-awareness of motor symptoms (ISAm) in PD might be reduced by increasing patients' mindfulness. A PD-specific mindfulness intervention has been developed and evaluated as a potential treatment option: IPSUM ("Insight into Parkinson's Disease Symptoms by using Mindfulness"). Methods: IPSUM's effectiveness is evaluated by comparing an intervention with a waitlist-control group. Applying a pre-post design, patients were assessed before, directly after and 8weeks after treatment. The primary outcome was the change in a quantitative ISAm score from baseline to post-assessment. Secondary outcome measures were PD-related affective changes and neuropsychological test performance. Feasibility was evaluated via feedback forms. Results: In total, 30 non-depressed and non-demented PD patients were included (intervention: n=14, waitlist-control: n=16). ISAm score did not change significantly, but the training group showed greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety. Cognitive disturbances, apathy, and sleeping problems worsened only in the waitlist-control group. Patients' feedback regarding the training concept and material was excellent. Conclusion: Insight into Parkinson's Disease Symptoms by using Mindfulness has not been capable of reducing ISAm in PD patients but appears to be a feasible and effective concept to, among others, support mental health in the mid-term. It has to be noted though that the study was stopped beforehand because of the SARS CoV-2 pandemic. The lack of findings might therefore be caused by a lack of statistical power. The need for further research to better understand the mechanisms of ISAm and its connection to mindfulness in PD is highlighted.

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Self-Awareness and Recovery of Independence With Strategy Training.

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Self-Awareness and Recovery of Independence With Strategy Training.

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