#COT2017 S90. Neurology

Factors associated with participation in life situations after stroke in community dwelling adults: a systematic review

By Leisle Ezekiel (@lezeki ‏)

Ezekiel presented part one of her three planned systematic reviews that explored factors associated with participation in life situations after stroke in community dwelling adults. The lack of long-term support after stroke and the changing stroke demographic (an increase in the under 55 population) were highlighted. We were reminded that, as Occupational Therapists, we work at adapting the intersection between person and environment making participation modifiable.

The criteria for inclusion in this systematic review was outlined to include studies that investigated biopsychosocial factors over time in quantitative data. I found the discussion around bias useful to remember when reading research. For example, studies that excluded people after experiencing a severe stroke or people with communication difficulties were omitted. These would be the populations that would have increased difficulty in participation and therefore, we would be eager to record their experiences. This resulted in a review of over 11,000 participants between the ages of 18-99 years old living at home or a care facility.

Time was tight in this session so I couldn’t record all the findings but in summary, every factor of life effected participation after stroke apart from the type of stroke (a clot or a bleed) and more evidence was needed around the factor of driving. It was clear little research has been carried out past one year after stroke but commented that having poor participation after one year resulted in continued poor participation. Of course, the more severe strokes experienced resulted in poorer participation. Social support looked to be a positive factor for participation. Studies commented depression after stroke was difficult to treat which led us nicely into the next study by Aisling Durkin. Finally, Ezekiel suggested treatment plans need a change in vision creating a top-down approach. Personally, I have just finished my first placement in acute stroke rehabilitation and enjoyed the overview of the research available that this session brought.

Exploring the current education levels and practices for the assessment and treatment for post-stroke anxiety and depression: a survey of occupational therapists, physiotherapists, and speech and language therapists in the UK

By Aisling Durkin (@ais_d)

Figures show that 30% of people after stroke experience depression and 25% with post-stroke anxiety (PSA). Durkin concurred with our previous speaker, Leisle Ezekiel, that psychological changes such as depression and PSA effects participation but also mobility and cause an increase in clients’ length of hospital stay. It was also reiterated that not all people are receiving their review six months after stroke. This study recruited its 421 participants through social media comprising of occupational therapists, physiotherapists, and speech and language therapists working across the United Kingdom.

The findings revealed there is limited guidance on what education all professions should receive regarding assessing and treating depression and PSA with only some speech and language therapists reporting they attended formal counselling training for depression. Those that had had formal or informal training were shown to assess for depression and PSA. The most popular formal assessment was the Hospital and Depression Score (HADS) but many were assessing informally or within a general hospital questionnaire. Surprisingly, among many interesting statistics, 4.25% of Speech and Language Therapist did not assess for PSA when patients had aphasia post-stroke. As for treatment, Occupational Therapists were performing lifestyle, group, peer-supported, and individual self-help workbook interventions for depression post-stroke. Whereas, goal-setting, relaxation, graded approaches to activities, CBT, and individual self-help workbook interventions were reported as being used to treat PSA.

A positive finding for many in the audience was the fact the majority of all the professions either agreed or strongly agreed that it is their responsibility to assess for these conditions after stroke. It was also encouraging to see the work physiotherapists were doing already in this area but on the other hand, there was room for improvement for speech and language therapists.

In conclusion, Durkin reveals the gap between guideline expectations and reality in practice regarding gaining education in this area. Echoes from Diane Cox’s Casson address, ‘publish, publish, publish,’ were heard in my mind as non-validated tools and interventions are being undertaken in stroke rehabilitation at present. The agreement of every profession accepting responsibility for assessing depression and PSA after stroke is a big encouragement and was discussed in the question period after this presentation.

 Blog Squad writer: Orla Hughes (@orlatheot)



#COT2017 S98. Closing Plenary

IMG_0316It’s always great to come together at the end of conference rather than all drifting off homeward and boy was this a session worth coming together for.

A session which informed, provoked thought, was full of humour and ended with the usual video roundup of photos you may have wished you knew were being taken at the time.

Jennifer Creek started the session by taking us on a journey from the origins of our profession to present day proposing that we should pay more attention to practice that is happening on the margins if we want to seek answers to some of the major challenges we face currently. It really challenged by thinking about what how power is invested in the centre and the influence this power exerts on a profession and the way it practices.

I had never really thought about the relationship between the origins of our profession and the rise in women’s movement from the late 19th century onwards but of course it made sense. How the liberation of women from the home and the domestic roles they had been cast in previously opened the door for them to take on wider more influential roles and responsibilities within society. Education, housing, contributing to the war effort and supporting those marginalised within society all became a focus of their work. Women started moving into professions where they had greater influence and ability to effect change.

Jennifer traced this journey across the Atlantic to the founding of the first school of occupational therapy and back to the origins of occupational therapy in the UK. It is of course always important to be reminded of our history but Jennifer’s journeying didn’t stop there.

Rather than this closing plenary being a lesson in our history we were taken one step further a step which felt a little less comfortable as Jennifer explored how thinking and practice in the USA and UK began to colonise our practice on a global level and dominate the centre ground of occupational therapy practice. Perhaps sharing her definition of margin may help illustrate this:

a physical place, a social space or a personal experience on the periphery of the social mainstream or dominant order. For every margin there is a core that represents some form or position of authority, power and privilege.

Jennifer shared how her experiences in South Africa had provided her with an opportunity to witness the resourcefulness, innovation and expertise that are occurring when you move further away from the constraints of the centre ground. She explored some of the characteristics of working at the margins – summarised on the slide below


Having worked in a small voluntary sector user led organisation in the late 1980s where funding was always an issue, the organisation was transitioning to becoming user led at the height of the rise of the disability movement and we were seeking new responses to meet demand – these all sound familiar. Exciting, challenging, liberating and scary are all be words I would use to describe that time.

Jennifer’s call: Explore the margins, places and spaces away from the mainstream if you want to discover places where creativity happens. This resented strongly with me.

DCxnlbvXgAEaYixTina Coldham. Chair of the Social Care Institute for Excellence (SCIE) Co-Production Network, SCIE Trustee and Mental Health Campaigner

Last night an OT Saved my Life

Well, what can I say – I’m not even going to try to summarise Tina’s presentation for you as I know I won’t do it justice. There are some great moment captured on twitter for you to explore – just explore the hashtag #COT2017.  You really did need to be in the room to experience the heartfelt, side splittingly funny way in which Tina talked about the impact of occupational therapy on her life.

Describing herself as, “a practicing depressive – because I’m still practicing!” and through all the laughter, banter and jokes there was a serious message as Tina reflected on the different ways in which her encounters with occupational therapists have supported her at different times in her life. She talked about what it meant to have someone who was interested in her rather than her diagnosis. How no area of discussion was out of bounds.

Perhaps it is enough to leave you wth Tina’s description of occupational therapy as ‘the art of the possible rather than the science of the impossible.’

If you didn’t make it to conference I really want to flag up that Tina will be hosting one of the weekly #OTalk researchers on co-creation in research. Watch this space because I just need to pin them down to a date but it will be the 1st Tuesday of the months some time in the future!

What a fitting note to end conference on – but then of course came the photos!

Written by @lynnegoodacre



#COT2017 Bridging the gap between inpatient and community Forensic Learning Disability service’s. Poster 54

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Poster P54
Bridging the gap between inpatient and community within a forensic learning disability service. Smalley L: Southern Health NHS Foundation Trust

Reference: Vona du Toit Model of Creative Ability Foundation UK .. 2017 .. What is the Vona du Toit Model of Creative Ability? (Online). Available at: http://www.vdtmocaf-uk.com/page/what-i s- the-vdt-moca [Accessed 12th June 2017]

Contact Email Address: L.Smalley@NHS.net

Blog shot by @Helen_OTUK


#COT2017 Participation in advanced age: enacting values, an adaptive process Poster P81

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Poster P81: Participation in advanced age: enacting values, an adaptive process
Sugarhood P: London South Bank University

References: Sugarhood, P., Eakin, P., Summerfield-Mann, L. (2016).
Participation in advanced older age: enacting values, an
adaptive process. Ageing and Society, Jun 20. doi: 10.1017/

Contact Email Address: p.sugarhood@lsbu.ac.uk

Blog Shot by @Helen_OTUK