Abstract
This study focused on the extent to which activity demands limit participation in high cognitively- and high physically-demanding activities. Various assessments of participation, fatigue, cognition, and motor ability were included. Results showed that perceived physical ability and cognitive ability were correlated with retention of these activities, but that fatigue had little effect. This study helps to better understand how activity demands relate of participation poststroke.
Primary Author and Speaker: Julianne Mitchell
Additional Authors and Speakers: Lisa Connor
Contributing Authors: Carolyn Baum, Marjorie Nicholas
The main objectives of this study were to determine the extent to which physical function related to participation in physically-demanding activities and cognitive abilities related to the participation in cognitively-demanding activities after stroke. Secondarily, we sought to determine if these relationships were mediated by fatigue. There are approximately 4 million stroke survivors in the United States, with 40% experiencing persistent moderate to severe impairments. Physical and cognitive impairments are the most common, and fatigue effects up to 77% of people post stroke, although often neglected in research. Despite the robust literature exploring participation post stroke, there is little work addressing the demands of activities and how they influence participation post-stroke. This study used a quasi-experimental, cross sectional design. Participants were persons living in the community at least six months post stroke and were able to withstand five hours of testing. Reliable yes/no responses with communication supports were required for persons with aphasia (PWA). Participants were recruited from local stroke and brain injury support groups in St. Louis, MO and Boston, MA.
Assessments were adapted for PWA and all participants were tested with the adapted versions. The Activity Card Sort (ACS) assessed participation in high cognitively- and high physically-demanding activities. Data from a previous study determined which activities from the ACS were considered to have high physical and cognitive skill requirements. The Stroke Impact Scale motor and strength domains assessed perceived strength and mobility. The NIH Stroke Scale motor items measured motor impairment. The Multidimensional Assessment of Fatigue measured self-reported fatigue, and the Delis Kaplan Executive Function System Trail Making and Design Fluency Tests assessed cognitive ability.
Multiple regressions analyses showed that 36.4% of the variance in high mobility activities were accounted for by the predictor variables, however only perceived strength/mobility was a significant independent predictor; 32.6% of the variance in high cognitive activities were accounted for by the predictor variables, with both cognitive abilities and perceived strength/mobility as significant independent predictors. Fatigue did not have a significant mediating effect on either dependent variable. Results indicated that self-perception of abilities may have more to do with participation than actual impairment. This study provides clinicians with a better understanding of the cognitive and physical dimensions of activities and their relation to participation post stroke. A better understanding of the underlying relationship between activity demands and participation will help occupational therapists create therapeutic interventions for their clients’ reengagement in valued life activities.
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Austin, C., Connor, L. T., Mandoske, V., & Fox, K. (2013). Clarifying activity dimensions within the activity card sort to enhance measurement of participation. Unpublished manuscript.